Yenidoğan dönemi idrar yolu enfeksiyonlarının değerlendirilmesi
Evaluation of newborn urinary tract infections
Yazar: GÜL DEMET KAYA ÖZÇORA
Danışman: UZMAN SULTAN KAVUNCUOĞLU
Sağlık Bakanlığı / İstanbul Kanuni Sultan Süleyman Eğitim ve Araştırma  Hastanesi / Tıp Eğitimi Ana Bilim Dalı / Çocuk Neonatoloji Bilim Dalı
Derece: Tıpta Uzmanlık, 2013
Konu: Çocuk Sağlığı ve Hastalıkları = Child Health and Diseases

Özet:
Üriner sistem enfeksiyonu yenidoğan ve çocukluk yaş grubunda sık görülen renal skarlaşma, hipertansiyon, kronik böbrek yetmezliği gibi uzun dönem komplikasyonları olan ciddi bir hastalıktır. Yenidoğan döneminde semptom ve bulguların nonspesifik olması nedeniyle tanısı zordur.
Bu çalışmada 0-30 günlük yenidoğanlarda üriner enfeksiyonun nedenleri, risk faktörleri, klinik tablo, üreyen mikroorganizmalar, görüntüleme yöntemleri tartışıldı. Erken tanı ve tedavinin önemi vurgulandı.
1 Haziran 2011-31 Aralık 2012 tarihleri arasında Eğitim ve Araştırma Hastanesi Yenidoğan Yoğun Bakım Ünitesi'ne yatan klinik sepsis semptom ve bulguları olan ve prenatal renal anomali tanısı alan hastalardan steril koşullarda (kateterle) idrar kültürü alındı. Kan kültürü ve enfeksiyon belirteçleri çalışıldı.
Olguların tanı anında ortalama yaşları 14,6 ± 9,5 gün (2-30 gün ) olup, nefrolojik takip süresi ortalama 12 ± 6 aydı. Hastaların %60,8'i (n=31) erkek, %39,2'si (n=20) kız olup ortalama doğum kilosu 3287,5 ± 520 gram (2400-4290 arası), ortalama gebelik haftası 38,2 ± 1,8(37-42 hafta) idi. Doğum şekli irdelendiğinde, %49'u (n=25) normal vajinal yolla, %51'i (n=26) sezaryen (c/s) ile doğmuştu.
Hastaların %33,3'ünde (n=17) enfeksiyona predispozisyon yaratacak risk faktörü vardı. Risk faktörleri; yoğun bakım ünitesinde yatış %11,8 (n=6), prenatal ultrasonografide anomali %15,7 (n=8), fimozis %2 (n=1), erken membran rüptürü %2 (n=1) ve anterior anüs %2 (n=1) idi.
Başvurularında %70,5(n=36)'unda şüpheli sepsis bulguları,%19,6'sında (n=10) sarılık, %5,9'unda (n=3) idrar yapma zorluğu şikayeti olup %3,9'unda (n=2) şikayet yoktu. 
Çalışmamızda pyüri sıklığı %68,6(n=35) idi. 17 hastada (%33,3) C-reaktif protein düzeyi pozitif saptandı.
Çalışmamızda hem toplum kökenli (%40) hem de nozokomiyal (%45,3) üriner sistem enfeksiyonunda en sık etken patojen  Klebsiella spp. saptandı.  
Hastaların %33,3'ünde (n=17) üriner sistem ultrasonografisinde patoloji saptandı. Bunlar 2 hastada hidronefroz, 2 hastada hidroüreteronefroz, 9 hastada pelviektazi, 1 hastada multipl kortikal kist, 1 hastada renal çapraz ektopi, 1 hastada duplikasyon anomalisi, 1 hastada sistosel idi. 
Prenatal ultrasonografi ile tanı alan hastalara postnatal ultrasonografi tekrarlandı. Renal pelvis dilatasyonu veya hidronefroz öyküsü 8 hastada vardı. İki hastadaki prenatal dilatasyon postnatal dönemde doğrulanmadı. Diğer olgulardan birinde üreteropelvik bileşke darlığı, 2 hastada posterior üretral valv, 1 olguda sistosel, ikisinde vezikoüreteral reflü saptandı. Bizim çalışmamızda prenatal ultrasonografinin sensitivitesi yüksek saptanmıştır.
Ultrasonografide renal anomali saptanan grupta enfeksiyona eğilim yaratacak risk faktörü görülme oranı ve reenfeksiyon görülme oranı normal gruptan anlamlı yüksekti (p< 0,05) . 
Çalışmamızda hastaların 35'inde yapılan voiding sistoüretrografi (VCUG) incelemesinde %40'ında (n=14) patoloji saptanmış olup vezikoüreteral reflü sıklığı %34,2 (n=12) olup literatür ile uyumluydu. İki hastada posterior üretral valv, 5 hastada düşük grade (grade 1-2), 7 hastada yüksek grade (3-4-5) reflü saptandı.
Üriner enfeksiyonu takiben 6 ay içinde yapılan dimerkaptosüksinik asit (DMSA) sintigrafilerinde skar saptanma oranı (n=14) %33,3 olarak saptandı, bulgular literatür ile benzerlik gösteriyordu. DMSA sonucu anormal olan grupta reenfeksiyon görülme oranı normal gruptan anlamlı yüksekti (p<0,05). Görüntüleme metodlarının tanı değeri ve birbirleriyle uyumu irdelendi. Ultrasonografi sonucu ile VCUG ve DMSA sonuçları arasında anlamlı uyumluluk vardı (Kappa:0,483 / p=0,004<0,05). VCUG sonucu ile DMSA sonucu arasında anlamlı uyumluluk vardı (Kappa:0,355 / p=0,043<0,05).
Vezikoüreteral reflünün spontan düzelmesi, reflünün derecesi ile ilgilidir. Çalışmamızda 12±6 aylık izlem sonucunda bir (%8,3) hastamızda grade 1 vezikoüreteral reflünün gerilediği saptandı. Düşük dereceli reflüsü olan hastalarda tekrarlayan enfeksiyon saptanmadı.
Takip sırasında 12(%23,5) hastada 1,5-12 ay arasında 25 nüks gözlemledik. Tekrarlayan enfeksiyon gözlenen 12 hastanın 8'inde zemin hazırlayan üriner sistem anomalisi vardı ve tekrarların %80'i ilk 6 ay içinde oluştu.
Çalışmamızda 5 hastamız da tekrarlayan üriner enfeksiyon ve renal fonksiyon kaybı nedeniyle (%9,8) cerrahi girişim uygulandı.
Çalışmamız bulguları eşliğinde ilk üriner sistem enfeksiyonu geçiren tüm çocuklara erken dönemde üriner sistem ultrasonografisi yapılması, patoloji saptanması ya da ek risk faktörleri varlığında veya reenfeksiyon durumunda VCUG ve DMSA ile değerlendirilmesinin gerektiğini ve ilk üriner sistem enfeksiyonu sonrası ilk 6 ay, aylık idrar kültürü ile takibin önemli olduğunu düşünmekteyiz.

Abstract:
Urinary tract infection is a serious disease frequently seen in neonates and pediatric age group, which has complications such as renal scarring, hypertension and chronic renal failure. The diagnosis is difficult due to nonspecific signs and symptoms in the newborn period.
In this study; the causes of urinary tract infections, risk factors, clinical presentation, causative microorganisms, imaging methods are discussed in infants between 0-30 days. The importance of early diagnosis and treatment was emphasized.
Urinary culture of patients was performed under sterile conditions (catheter), who has clinical signs and symptoms of sepsis and renal anomalies diagnosed prenatally between 1 June 2011 to 31 December 2012 in Kanuni Sultan Süleyman Education and Research Hospital Neonatal Intensive Care Unit.
The mean age of the patients at diagnosis was 14.6 ± 9.5 days (2-30 days) and the average nephrologic follow-up period was 12 ± 6 months. 60.8% (n=31) of the patients were male and 39.2% (n=20) were female and the mean birth weight was 3287.5 ± 520 grams (between 2400-4290), the mean gestational age was 38.2 ± 1.8 (37-42 weeks). 49% of the patients (n=25) was born by normal vaginal delivery and 51% (n=26) by cesarean section (c/s). 
33.3% (n=17) of patients had risk factors that predisposed to infection. Risk factors were hospitalization in the intensive care unit 11.8% (n=6), anomaly in prenatal ultrasonography 15.7% (n=8), phimosis 2% (n=1), early ruptures of membranes 2% (n=1), and anterior anus% 2 (n=1).
On admission, there were signs of suspected sepsis by 70.5% (n=36) of patients, jaundice by 19.6% (n=10) of patients and 5.9% (n=3) had been suffering from difficulty in urination and 3.9% of the patients (n=2) had no symptoms.
In our study, the frequency of pyuria was 68.6% (n=35). 17 patients (33.3%) were positive for C-reactive protein levels.
In our study, both in community-acquired (40%) and nosocomial (45.3%), urinary tract infections, the most common causative pathogen was Klebsiella spp.
Pathology was detected in 33.3% (n=17) of patients in the urinary tract ultrasonography. These pathologies were hydronephrosis in 2 patients, hydroureteronephrosis in 2 patients, pelviectasis in 9 patients, multiple cortical cysts in one patient, renal cross ectopia in one patient, duplication anomalies in one patient and cystocele in one patient.
Postnatally ultrasonography was repeated by patients who are diagnosed by prenatal ultrasonography. Prenatally 8 patients had a history of renal pelvis dilatation or hydronephrosis. The history of prenatal dilatation of two patients was not confirmed postnatally. By other cases, ureteropelvic junction stenosis was detected in 1 patient, posterior urethral valv in 2 patients, cystocele in 1 patient and vesicoureteral reflux in 2 patients. In our study, we found a high sensitivity of prenatal ultrasonography.
The incidence of risk factors that predisposed to infection and the incidence of reinfection in the group with renal anomaly by ultrasonography was significantly higher than the normal group (p< 0,05).
In our study, 40% (n=14) of 35 patients with the voiding cystourethrography (VCUG) examination, pathological findings were identified. The frequency of vesicoureteral reflux was 34.2% (n=12), and consistent with the literature. Posterior urethral valve was detected in two patients, 5 patients had low-grade (grade 1-2), 7 patients had high grade (3-4-5) reflux.
The detection rate of the scar of dimercaptosuccinic acid (DMSA) scintigraphy, which is made within six months following urinary tract infection was 33.3% (n=14) and these findings were similar to the literature. The incidence of reinfection of the group with abnormal DMSA outcomes was significantly higher than the normal group (p<0,05). The diagnostic value of imaging techniques and compliance with each other were evaluated. There was a significant correlation between the outcomes of ultrasonography and the outcomes of VCUG and DMSA (Kappa:0,483 / p=0,004<0,05). There was a significant correlation between the outcomes of VCUG and DMSA (Kappa:0,355 / p=0,043<0,05).
Spontaneous improvement of vesicoureteral reflux, is related to the degree of reflux. In our study, we determined regression in one (8.3%) of our patients with grade 1 vesicoureteral reflux at the end of 12 ± 6 months follow-up. There was no recurrent infection in patients with low-grade reflux.
During the follow-up period, we observed 25 recurrences in 12 (23.5%) patients in a period of 1.5 to 12 months. There was predisposing urinary tract anomalies in 8 of 12 patients with recurrent infection and 80% of recurrences occurred within the first 6 months.
In our study, surgical intervention was performed in 5 of our patients (9.8%) due to recurrent urinary tract infections and renal function loss.
With the findings of our study we suggest ultrasonography evaluation in the early period for all children undergoing urinary tract infection for the first time. We consider that VCUG and DMSA evaluation should be performed when pathology was determinated or additional risk factors exists or in case of reinfection and we consider it is important to follow-up monthly with urinary culture for the first 6 months after the first urinary tract infection underwent.














Urinary tract infection is a serious disease frequently seen in neonates and pediatric age group, which has complications such as renal scarring, hypertension and chronic renal failure. The diagnosis is difficult due to nonspecific signs and symptoms in the newborn period.
In this study; the causes of urinary tract infections, risk factors, clinical presentation, causative microorganisms, imaging methods are discussed in infants between 0-30 days. The importance of early diagnosis and treatment was emphasized.
Urinary culture of patients was performed under sterile conditions (catheter), who has clinical signs and symptoms of sepsis and renal anomalies diagnosed prenatally between 1 June 2011 to 31 December 2012 in Kanuni Sultan Süleyman Education and Research Hospital Neonatal Intensive Care Unit.
The mean age of the patients at diagnosis was 14.6 ± 9.5 days (2-30 days) and the average nephrologic follow-up period was 12 ± 6 months. 60.8% (n=31) of the patients were male and 39.2% (n=20) were female and the mean birth weight was 3287.5 ± 520 grams (between 2400-4290), the mean gestational age was 38.2 ± 1.8 (37-42 weeks). 49% of the patients (n=25) was born by normal vaginal delivery and 51% (n=26) by cesarean section (c/s). 
33.3% (n=17) of patients had risk factors that predisposed to infection. Risk factors were hospitalization in the intensive care unit 11.8% (n=6), anomaly in prenatal ultrasonography 15.7% (n=8), phimosis 2% (n=1), early ruptures of membranes 2% (n=1), and anterior anus% 2 (n=1).
On admission, there were signs of suspected sepsis by 70.5% (n=36) of patients, jaundice by 19.6% (n=10) of patients and 5.9% (n=3) had been suffering from difficulty in urination and 3.9% of the patients (n=2) had no symptoms.
In our study, the frequency of pyuria was 68.6% (n=35). 17 patients (33.3%) were positive for C-reactive protein levels.
In our study, both in community-acquired (40%) and nosocomial (45.3%), urinary tract infections, the most common causative pathogen was Klebsiella spp.
Pathology was detected in 33.3% (n=17) of patients in the urinary tract ultrasonography. These pathologies were hydronephrosis in 2 patients, hydroureteronephrosis in 2 patients, pelviectasis in 9 patients, multiple cortical cysts in one patient, renal cross ectopia in one patient, duplication anomalies in one patient and cystocele in one patient.
Postnatally ultrasonography was repeated by patients who are diagnosed by prenatal ultrasonography. Prenatally 8 patients had a history of renal pelvis dilatation or hydronephrosis. The history of prenatal dilatation of two patients was not confirmed postnatally. By other cases, ureteropelvic junction stenosis was detected in 1 patient, posterior urethral valv in 2 patients, cystocele in 1 patient and vesicoureteral reflux in 2 patients. In our study, we found a high sensitivity of prenatal ultrasonography.
The incidence of risk factors that predisposed to infection and the incidence of reinfection in the group with renal anomaly by ultrasonography was significantly higher than the normal group (p< 0,05).
In our study, 40% (n=14) of 35 patients with the voiding cystourethrography (VCUG) examination, pathological findings were identified. The frequency of vesicoureteral reflux was 34.2% (n=12), and consistent with the literature. Posterior urethral valve was detected in two patients, 5 patients had low-grade (grade 1-2), 7 patients had high grade (3-4-5) reflux.
The detection rate of the scar of dimercaptosuccinic acid (DMSA) scintigraphy, which is made within six months following urinary tract infection was 33.3% (n=14) and these findings were similar to the literature. The incidence of reinfection of the group with abnormal DMSA outcomes was significantly higher than the normal group (p<0,05). The diagnostic value of imaging techniques and compliance with each other were evaluated. There was a significant correlation between the outcomes of ultrasonography and the outcomes of VCUG and DMSA (Kappa:0,483 / p=0,004<0,05). There was a significant correlation between the outcomes of VCUG and DMSA (Kappa:0,355 / p=0,043<0,05).
Spontaneous improvement of vesicoureteral reflux, is related to the degree of reflux. In our study, we determined regression in one (8.3%) of our patients with grade 1 vesicoureteral reflux at the end of 12 ± 6 months follow-up. There was no recurrent infection in patients with low-grade reflux.
During the follow-up period, we observed 25 recurrences in 12 (23.5%) patients in a period of 1.5 to 12 months. There was predisposing urinary tract anomalies in 8 of 12 patients with recurrent infection and 80% of recurrences occurred within the first 6 months.
In our study, surgical intervention was performed in 5 of our patients (9.8%) due to recurrent urinary tract infections and renal function loss.
With the findings of our study we suggest ultrasonography evaluation in the early period for all children undergoing urinary tract infection for the first time. We consider that VCUG and DMSA evaluation should be performed when pathology was determinated or additional risk factors exists or in case of reinfection and we consider it is important to follow-up monthly with urinary culture for the first 6 months after the first urinary tract infection underwent.














Urinary tract infection is a serious disease frequently seen in neonates and pediatric age group, which has complications such as renal scarring, hypertension and chronic renal failure. The diagnosis is difficult due to nonspecific signs and symptoms in the newborn period.
In this study; the causes of urinary tract infections, risk factors, clinical presentation, causative microorganisms, imaging methods are discussed in infants between 0-30 days. The importance of early diagnosis and treatment was emphasized.
Urinary culture of patients was performed under sterile conditions (catheter), who has clinical signs and symptoms of sepsis and renal anomalies diagnosed prenatally between 1 June 2011 to 31 December 2012 in Kanuni Sultan Süleyman Education and Research Hospital Neonatal Intensive Care Unit.
The mean age of the patients at diagnosis was 14.6 ± 9.5 days (2-30 days) and the average nephrologic follow-up period was 12 ± 6 months. 60.8% (n=31) of the patients were male and 39.2% (n=20) were female and the mean birth weight was 3287.5 ± 520 grams (between 2400-4290), the mean gestational age was 38.2 ± 1.8 (37-42 weeks). 49% of the patients (n=25) was born by normal vaginal delivery and 51% (n=26) by cesarean section (c/s). 
33.3% (n=17) of patients had risk factors that predisposed to infection. Risk factors were hospitalization in the intensive care unit 11.8% (n=6), anomaly in prenatal ultrasonography 15.7% (n=8), phimosis 2% (n=1), early ruptures of membranes 2% (n=1), and anterior anus% 2 (n=1).
On admission, there were signs of suspected sepsis by 70.5% (n=36) of patients, jaundice by 19.6% (n=10) of patients and 5.9% (n=3) had been suffering from difficulty in urination and 3.9% of the patients (n=2) had no symptoms.
In our study, the frequency of pyuria was 68.6% (n=35). 17 patients (33.3%) were positive for C-reactive protein levels.
In our study, both in community-acquired (40%) and nosocomial (45.3%), urinary tract infections, the most common causative pathogen was Klebsiella spp.
Pathology was detected in 33.3% (n=17) of patients in the urinary tract ultrasonography. These pathologies were hydronephrosis in 2 patients, hydroureteronephrosis in 2 patients, pelviectasis in 9 patients, multiple cortical cysts in one patient, renal cross ectopia in one patient, duplication anomalies in one patient and cystocele in one patient.
Postnatally ultrasonography was repeated by patients who are diagnosed by prenatal ultrasonography. Prenatally 8 patients had a history of renal pelvis dilatation or hydronephrosis. The history of prenatal dilatation of two patients was not confirmed postnatally. By other cases, ureteropelvic junction stenosis was detected in 1 patient, posterior urethral valv in 2 patients, cystocele in 1 patient and vesicoureteral reflux in 2 patients. In our study, we found a high sensitivity of prenatal ultrasonography.
The incidence of risk factors that predisposed to infection and the incidence of reinfection in the group with renal anomaly by ultrasonography was significantly higher than the normal group (p< 0,05).
In our study, 40% (n=14) of 35 patients with the voiding cystourethrography (VCUG) examination, pathological findings were identified. The frequency of vesicoureteral reflux was 34.2% (n=12), and consistent with the literature. Posterior urethral valve was detected in two patients, 5 patients had low-grade (grade 1-2), 7 patients had high grade (3-4-5) reflux.
The detection rate of the scar of dimercaptosuccinic acid (DMSA) scintigraphy, which is made within six months following urinary tract infection was 33.3% (n=14) and these findings were similar to the literature. The incidence of reinfection of the group with abnormal DMSA outcomes was significantly higher than the normal group (p<0,05). The diagnostic value of imaging techniques and compliance with each other were evaluated. There was a significant correlation between the outcomes of ultrasonography and the outcomes of VCUG and DMSA (Kappa:0,483 / p=0,004<0,05). There was a significant correlation between the outcomes of VCUG and DMSA (Kappa:0,355 / p=0,043<0,05).
Spontaneous improvement of vesicoureteral reflux, is related to the degree of reflux. In our study, we determined regression in one (8.3%) of our patients with grade 1 vesicoureteral reflux at the end of 12 ± 6 months follow-up. There was no recurrent infection in patients with low-grade reflux.
During the follow-up period, we observed 25 recurrences in 12 (23.5%) patients in a period of 1.5 to 12 months. There was predisposing urinary tract anomalies in 8 of 12 patients with recurrent infection and 80% of recurrences occurred within the first 6 months.
In our study, surgical intervention was performed in 5 of our patients (9.8%) due to recurrent urinary tract infections and renal function loss.
With the findings of our study we suggest ultrasonography evaluation in the early period for all children undergoing urinary tract infection for the first time. We consider that VCUG and DMSA evaluation should be performed when pathology was determinated or additional risk factors exists or in case of reinfection and we consider it is important to follow-up monthly with urinary culture for the first 6 months after the first urinary tract infection underwent.














Urinary tract infection is a serious disease frequently seen in neonates and pediatric age group, which has complications such as renal scarring, hypertension and chronic renal failure. The diagnosis is difficult due to nonspecific signs and symptoms in the newborn period.
In this study; the causes of urinary tract infections, risk factors, clinical presentation, causative microorganisms, imaging methods are discussed in infants between 0-30 days. The importance of early diagnosis and treatment was emphasized.
Urinary culture of patients was performed under sterile conditions (catheter), who has clinical signs and symptoms of sepsis and renal anomalies diagnosed prenatally between 1 June 2011 to 31 December 2012 in Kanuni Sultan Süleyman Education and Research Hospital Neonatal Intensive Care Unit.
The mean age of the patients at diagnosis was 14.6 ± 9.5 days (2-30 days) and the average nephrologic follow-up period was 12 ± 6 months. 60.8% (n=31) of the patients were male and 39.2% (n=20) were female and the mean birth weight was 3287.5 ± 520 grams (between 2400-4290), the mean gestational age was 38.2 ± 1.8 (37-42 weeks). 49% of the patients (n=25) was born by normal vaginal delivery and 51% (n=26) by cesarean section (c/s). 
33.3% (n=17) of patients had risk factors that predisposed to infection. Risk factors were hospitalization in the intensive care unit 11.8% (n=6), anomaly in prenatal ultrasonography 15.7% (n=8), phimosis 2% (n=1), early ruptures of membranes 2% (n=1), and anterior anus% 2 (n=1).
On admission, there were signs of suspected sepsis by 70.5% (n=36) of patients, jaundice by 19.6% (n=10) of patients and 5.9% (n=3) had been suffering from difficulty in urination and 3.9% of the patients (n=2) had no symptoms.
In our study, the frequency of pyuria was 68.6% (n=35). 17 patients (33.3%) were positive for C-reactive protein levels.
In our study, both in community-acquired (40%) and nosocomial (45.3%), urinary tract infections, the most common causative pathogen was Klebsiella spp.
Pathology was detected in 33.3% (n=17) of patients in the urinary tract ultrasonography. These pathologies were hydronephrosis in 2 patients, hydroureteronephrosis in 2 patients, pelviectasis in 9 patients, multiple cortical cysts in one patient, renal cross ectopia in one patient, duplication anomalies in one patient and cystocele in one patient.
Postnatally ultrasonography was repeated by patients who are diagnosed by prenatal ultrasonography. Prenatally 8 patients had a history of renal pelvis dilatation or hydronephrosis. The history of prenatal dilatation of two patients was not confirmed postnatally. By other cases, ureteropelvic junction stenosis was detected in 1 patient, posterior urethral valv in 2 patients, cystocele in 1 patient and vesicoureteral reflux in 2 patients. In our study, we found a high sensitivity of prenatal ultrasonography.
The incidence of risk factors that predisposed to infection and the incidence of reinfection in the group with renal anomaly by ultrasonography was significantly higher than the normal group (p< 0,05).
In our study, 40% (n=14) of 35 patients with the voiding cystourethrography (VCUG) examination, pathological findings were identified. The frequency of vesicoureteral reflux was 34.2% (n=12), and consistent with the literature. Posterior urethral valve was detected in two patients, 5 patients had low-grade (grade 1-2), 7 patients had high grade (3-4-5) reflux.
The detection rate of the scar of dimercaptosuccinic acid (DMSA) scintigraphy, which is made within six months following urinary tract infection was 33.3% (n=14) and these findings were similar to the literature. The incidence of reinfection of the group with abnormal DMSA outcomes was significantly higher than the normal group (p<0,05). The diagnostic value of imaging techniques and compliance with each other were evaluated. There was a significant correlation between the outcomes of ultrasonography and the outcomes of VCUG and DMSA (Kappa:0,483 / p=0,004<0,05). There was a significant correlation between the outcomes of VCUG and DMSA (Kappa:0,355 / p=0,043<0,05).
Spontaneous improvement of vesicoureteral reflux, is related to the degree of reflux. In our study, we determined regression in one (8.3%) of our patients with grade 1 vesicoureteral reflux at the end of 12 ± 6 months follow-up. There was no recurrent infection in patients with low-grade reflux.
During the follow-up period, we observed 25 recurrences in 12 (23.5%) patients in a period of 1.5 to 12 months. There was predisposing urinary tract anomalies in 8 of 12 patients with recurrent infection and 80% of recurrences occurred within the first 6 months.
In our study, surgical intervention was performed in 5 of our patients (9.8%) due to recurrent urinary tract infections and renal function loss.
With the findings of our study we suggest ultrasonography evaluation in the early period for all children undergoing urinary tract infection for the first time. We consider that VCUG and DMSA evaluation should be performed when pathology was determinated or additional risk factors exists or in case of reinfection and we consider it is important to follow-up monthly with urinary culture for the first 6 months after the first urinary tract infection underwent.













Urinary tract infection is a serious disease frequently seen in neonates and pediatric age group, which has complications such as renal scarring, hypertension and chronic renal failure. The diagnosis is difficult due to nonspecific signs and symptoms in the newborn period.
In this study; the causes of urinary tract infections, risk factors, clinical presentation, causative microorganisms, imaging methods are discussed in infants between 0-30 days. The importance of early diagnosis and treatment was emphasized.
Urinary culture of patients was performed under sterile conditions (catheter), who has clinical signs and symptoms of sepsis and renal anomalies diagnosed prenatally between 1 June 2011 to 31 December 2012 in Kanuni Sultan Süleyman Education and Research Hospital Neonatal Intensive Care Unit.
The mean age of the patients at diagnosis was 14.6 ± 9.5 days (2-30 days) and the average nephrologic follow-up period was 12 ± 6 months. 60.8% (n=31) of the patients were male and 39.2% (n=20) were female and the mean birth weight was 3287.5 ± 520 grams (between 2400-4290), the mean gestational age was 38.2 ± 1.8 (37-42 weeks). 49% of the patients (n=25) was born by normal vaginal delivery and 51% (n=26) by cesarean section (c/s). 
33.3% (n=17) of patients had risk factors that predisposed to infection. Risk factors were hospitalization in the intensive care unit 11.8% (n=6), anomaly in prenatal ultrasonography 15.7% (n=8), phimosis 2% (n=1), early ruptures of membranes 2% (n=1), and anterior anus% 2 (n=1).
On admission, there were signs of suspected sepsis by 70.5% (n=36) of patients, jaundice by 19.6% (n=10) of patients and 5.9% (n=3) had been suffering from difficulty in urination and 3.9% of the patients (n=2) had no symptoms.
In our study, the frequency of pyuria was 68.6% (n=35). 17 patients (33.3%) were positive for C-reactive protein levels.
In our study, both in community-acquired (40%) and nosocomial (45.3%), urinary tract infections, the most common causative pathogen was Klebsiella spp.
Pathology was detected in 33.3% (n=17) of patients in the urinary tract ultrasonography. These pathologies were hydronephrosis in 2 patients, hydroureteronephrosis in 2 patients, pelviectasis in 9 patients, multiple cortical cysts in one patient, renal cross ectopia in one patient, duplication anomalies in one patient and cystocele in one patient.
Postnatally ultrasonography was repeated by patients who are diagnosed by prenatal ultrasonography. Prenatally 8 patients had a history of renal pelvis dilatation or hydronephrosis. The history of prenatal dilatation of two patients was not confirmed postnatally. By other cases, ureteropelvic junction stenosis was detected in 1 patient, posterior urethral valv in 2 patients, cystocele in 1 patient and vesicoureteral reflux in 2 patients. In our study, we found a high sensitivity of prenatal ultrasonography.
The incidence of risk factors that predisposed to infection and the incidence of reinfection in the group with renal anomaly by ultrasonography was significantly higher than the normal group (p< 0,05).
In our study, 40% (n=14) of 35 patients with the voiding cystourethrography (VCUG) examination, pathological findings were identified. The frequency of vesicoureteral reflux was 34.2% (n=12), and consistent with the literature. Posterior urethral valve was detected in two patients, 5 patients had low-grade (grade 1-2), 7 patients had high grade (3-4-5) reflux.
The detection rate of the scar of dimercaptosuccinic acid (DMSA) scintigraphy, which is made within six months following urinary tract infection was 33.3% (n=14) and these findings were similar to the literature. The incidence of reinfection of the group with abnormal DMSA outcomes was significantly higher than the normal group (p<0,05). The diagnostic value of imaging techniques and compliance with each other were evaluated. There was a significant correlation between the outcomes of ultrasonography and the outcomes of VCUG and DMSA (Kappa:0,483 / p=0,004<0,05). There was a significant correlation between the outcomes of VCUG and DMSA (Kappa:0,355 / p=0,043<0,05).
Spontaneous improvement of vesicoureteral reflux, is related to the degree of reflux. In our study, we determined regression in one (8.3%) of our patients with grade 1 vesicoureteral reflux at the end of 12 ± 6 months follow-up. There was no recurrent infection in patients with low-grade reflux.
During the follow-up period, we observed 25 recurrences in 12 (23.5%) patients in a period of 1.5 to 12 months. There was predisposing urinary tract anomalies in 8 of 12 patients with recurrent infection and 80% of recurrences occurred within the first 6 months.
In our study, surgical intervention was performed in 5 of our patients (9.8%) due to recurrent urinary tract infections and renal function loss.
With the findings of our study we suggest ultrasonography evaluation in the early period for all children undergoing urinary tract infection for the first time. We consider that VCUG and DMSA evaluation should be performed when pathology was determinated or additional risk factors exists or in case of reinfection and we consider it is important to follow-up monthly with urinary culture for the first 6 months after the first urinary tract infection underwent.