title: Managing children under 36 months of age with febrile urinary tract infection: a new approach.
abstract: BACKGROUND
  Recent guidelines on urinary tract infection (UTI) agree on reducing the number of invasive procedures. None of these has been validated by a long-term study. We describe our 11-years experience in the application of a diagnostic protocol that uses a reduced number of invasive procedures.
  
  
  METHODS
  We reviewed retrospectively the records of 406 children aged between 1 and 36 months at their first UTI. All patients underwent renal ultrasound (RUS). Children with abnormal RUS and those with UTI recurrences underwent voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) renal scans.
  
  
  RESULTS
  RUS after the first UTI was pathological in 7.4% children; 4.4 % had a second UTI. We performed 48 VCUG: 14 patients (29%) had vesicoureteral reflux (VUR), 12 of which showed an abnormal RUS while 2 had recurrent UTI. After DMSA renal scan renal damage appeared in only 6 of them (12.5%); all these children showed grade IV VUR.
  
  
  CONCLUSIONS
  The application of our guidelines leads to a decrease in invasive examinations without missing any useful diagnoses or compromising the child's health.
authors.affiliation: Department of Pediatrics, Institute for Child and Maternal Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy. pennesi@burlo.trieste.it
authors.forename: Marco
authors.initials: M
authors.lastname: Pennesi
authors.forename: Ines
authors.initials: I
authors.lastname: L'erario
authors.forename: Laura
authors.initials: L
authors.lastname: Travan
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ventura
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents