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Imaging Practices and Implications in Young Infants With Urinary Tract Infection. Hosp Pediatr 2022 Nov 01;12(11):922-932

Date

10/25/2022

Pubmed ID

36278285

DOI

10.1542/hpeds.2021-006507

Abstract

OBJECTIVES: Management of infants aged ≤60 days with urinary tract infections (UTI) is challenging. We examined renal imaging in infants aged ≤60 days with UTI at a tertiary care children's hospital to identify the impact of standardizing renal ultrasound (RUS) interpretation.

METHODS: We retrospectively studied infants aged ≤60 days hospitalized for UTI or fever with urine culture and renal imaging obtained and final diagnosis of UTI. RUS initially had noncriterion-based (NCB) interpretation by experienced pediatric radiologists. For this study, a single pediatric radiologist used a criterion-based (CB) hydronephrosis grading system to reinterpret films initially classified as "abnormal" on the NCB reading. We compared final renal imaging results between NCB and CB groups.

RESULTS: Of 193 infants, 180 (93%) had inpatient RUS with 114 (63%) abnormal NCB interpretation. Of those with initially abnormal NCB interpretation, 85 OF 114 (75%) had minor and 29 OF 114 (25%) had significant abnormality by CB reinterpretation. In follow-up, the CB "minor abnormality" group showed 25% abnormal renal imaging, whereas the "significant abnormality" group showed 77% abnormal renal imaging with 54% having high-grade reflux on a voiding cystourethrogram (VCUG). Patients with CB inpatient RUS minor abnormality showed 3% abnormal RUS at follow-up, but 13% showed high-grade reflux on VCUG.

CONCLUSIONS: Standardized RUS interpretation in young infants with UTI improved the accuracy of identification of abnormalities on follow-up renal imaging. In patients with CB minor abnormality on inpatient RUS, our results suggest limited utility of follow-up RUS; however, follow-up VCUG remained useful to identify high-grade reflux.

Author List

Swartz S, Thakrar P, Kolinski J, Hadjiev J, Chou E, Zhang J, Yan K, Havens P

Authors

Erica Y. Chou MD Director, Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Jennifer M. Hadjiev MD Chief, Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Sheila Swartz MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Pooja Thakrar MD Associate Professor in the Radiology department at Medical College of Wisconsin
Ke Yan PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Child
Cystography
Humans
Infant
Retrospective Studies
Ultrasonography
Urinary Tract Infections
Vesico-Ureteral Reflux