Screening for Urinary Tract Infection Is Unnecessary in Prolonged Neonatal Jaundice

Summary and Comment |
March 8, 2016

Screening for Urinary Tract Infection Is Unnecessary in Prolonged Neonatal Jaundice

  1. F. Bruder Stapleton, MD

None of 279 well-appearing neonates with prolonged jaundice had UTI in a retrospective U.K. study.

  1. F. Bruder Stapleton, MD

On the basis of scant medical evidence, urinary tract infection (UTI) is purported to be an etiology for prolonged jaundice in neonates. The U.K.'s National Institute for Health and Care Excellence recommends obtaining a urine culture in the diagnosis of neonates with jaundice lasting more than two weeks. To evaluate the validity of this recommendation, researchers at an outpatient prolonged jaundice clinic in the U.K. reviewed 279 urine cultures from 179 well-appearing boys and 100 girls (average age, 27 days) during a 3-year period.

Urine cultures were obtained in a sterile urine collection bag. Of the 279 cultures, 145 were negative and 114 had mixed bacterial growth and were considered contaminated. Five cultures grew >100,000 colony-forming units/mL of a single organism but were considered false positives based on subsequent nondiagnostic confirmatory cultures. Two children with false-positive cultures received antibiotic therapy. No infant had confirmed UTI.

The authors also conducted a literature review and identified 18 published reports from around the world. Among the 6 that exclusively studied infants with prolonged jaundice, the incidence of UTI varied from 0% to 14.9%.

Comment

These results suggest that a urine culture is not necessary in well-appearing neonates with prolonged jaundice. Not obtaining urine cultures in neonates with jaundice would not only save money, it would also avoid unnecessary exposure to antibiotics and, potentially, additional diagnostic imaging.

Editor Disclosures at Time of Publication

  • Disclosures for F. Bruder Stapleton, MD at time of publication Editorial boards UpToDate

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