title: Screening high-grade vesicoureteral reflux in young infants with a febrile urinary tract infection.
abstract: BACKGROUND
  The lack of good evidence for improved outcomes in children and young infants with febrile urinary tract infection (UTI) after aggressive treatment for vesicoureteral reflux (VUR) has raised doubts regarding the need for routine voiding cystourethrography (VCUG), and the appropriate imaging evaluation in these children remains controversial.
  
  
  OBJECTIVE
  This prospective study aimed to determine whether abnormalities found on acute dimercaptosuccinic acid (DMSA) scan and ultrasound (US) can help indicate the necessity of voiding cystourethrography (VCUG) in young infants.
  
  
  METHODS
  For 3.5 years, all infants younger than 3 months presenting with first febrile UTI were prospectively studied. All infants were hospitalized and investigated using US (<3 days after admission), DMSA scan (<5 days after admission), and VCUG (7-10 days after antibiotic treatment) after diagnosis. The association among findings of US, DMSA scan, and VCUG were evaluated.
  
  
  RESULTS
  From 220 infants, there were abnormal results in 136 (61.8%) US and in 111 (50.5%) DMSA scans. By US, ten infants (4.5%) with abscess or structural abnormalities other than VUR were diagnosed. High-grade (III-V) VUR was present in 39 patients (17.7%). The sensitivities for high-grade VUR of renal US alone (76.9%) or DMSA scan alone (82.1%) were not as good as that of the "OR rule" strategy, which had 92.3% sensitivity and 94.3% negative predictive value.
  
  
  CONCLUSIONS
  To screen high-grade VUR in young infants with febrile UTI, US and acute DMSA scan could be performed first. VCUG is only indicated when abnormalities are apparent on either US or DMSA scan or both.
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, No 92, Section 2, Chungshan North Road, Taipei, Taiwan.
authors.forename: Jeng-Daw
authors.initials: JD
authors.lastname: Tsai
authors.forename: Chang-Ting
authors.initials: CT
authors.lastname: Huang
authors.forename: Pei-Yi
authors.initials: PY
authors.lastname: Lin
authors.forename: Jui-Hsing
authors.initials: JH
authors.lastname: Chang
authors.forename: Ming-Dar
authors.initials: MD
authors.lastname: Lee
authors.forename: Fu-Yuan
authors.initials: FY
authors.lastname: Huang
authors.forename: Bing-Fu
authors.initials: BF
authors.lastname: Shih
authors.forename: Han-Yang
authors.initials: HY
authors.lastname: Hung
authors.forename: Chyong-Hsin
authors.initials: CH
authors.lastname: Hsu
authors.forename: Hsin-An
authors.initials: HA
authors.lastname: Kao
authors.forename: Chun-Chen
authors.initials: CC
authors.lastname: Lin
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013624:Taiwan; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging
chemical_list: D000900:Anti-Bacterial Agents; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid