Bilirubin levels predict renal cortical changes in jaundiced neonates with urinary tract infection.
BACKGROUND
This study was undertaken to determine the incidence of urinary tract infection (UTI) and the frequency of anatomical abnormalities in newborns with unexplained jaundice and to find out if there is any correlation between bilirubin level and renal damage.


METHODS
We studied 462 full-term neonates for UTI. They were aged 3-25 days, with either high (>10 mg/dL) or prolonged (>10 days) hyperbilirubinemia, with or without manifestations such as fever, vomiting, diarrhea, poor feeding, lethargy, and irritability. Neonates positive for UTI were further investigated with ultrasound, cystourethrography, and acute phase renal scintigraphy with technetium-99m dimercaptosuccinate acid (DMSA).


RESULTS
Thirty neonates (6.5%) were found to have UTI. Twenty-eight of them had indirect hyperbilirubinemia and two had direct hyperbilirubinemia, with total bilirubin levels of 11.8-20.1 mg/dL. None of the neonates was found to have jaundice because of other reasons such as infection. Vesicoureteral reflux was found in 5 neonates and one of them was combined with hydronephrosis. Renal scintigraphy with technetium-99m DMSA showed renal cortex changes in 14 (46.7%) of the 30 neonates with UTI. These 14 neonates also had increased levels of bilirubin in comparison to those with normal findings of DMSA.


CONCLUSIONS
The incidence of UTI in uncomplicated neonatal jaundice is relatively high. Anatomical abnormalities of the urinary tract are not rare in infected children. Increased bilirubin levels are related to pathological findings in renal scintigraphy.
Xinias
Ioannis
I
3rd Department of Pediatrics, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece. xinias@auth.gr
Demertzidou
Vasiliki
V
Mavroudi
Antigoni
A
Kollios
Konstantinos
K
Kardaras
Panagiotis
P
Papachristou
Fotis
F
Arsos
Georgios
G
Tsiouris
Ioannis
I
D001663:Bilirubin / Q000097:blood*; D015897:Comorbidity; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D006869:Hydronephrosis / Q000097:blood* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015994:Incidence; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D007672:Kidney Cortex / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D014552:Urinary Tract Infections / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014718:Vesico-Ureteral Reflux / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology
D001663:Bilirubin