Journal Article

1420 A retrospective study of urinalysis in the prolonged jaundice clinic

Sheaff, Emma, Brightwell, Alex, Schindler, Nick

2021

Overview

BackgroundUrinary Tract Infections (UTIs) are common in the paediatric population and can cause life-threatening illness and significant morbidity. Clinical diagnosis remains a challenge owing to non-specific symptoms and clinical overlap with other common paediatric conditions. Prolonged jaundice may be the only clinical manifestation of an underlying UTI, and the National Institute for Health and Care Excellence (NICE) recommends that all neonates with prolonged jaundice should have a mid-stream urine (MSU) sample sent for culture. However, the evidence base behind this guidance remains unclear and has been challenged in recent literature.ObjectivesTo assess the local incidence of positive urine cultures in neonates with isolated prolonged jaundice.To compare the local incidence of positive urine cultures in neonates with isolated prolonged jaundice to published literature.To review how asymptomatic neonates with a positive culture were managed by our service.MethodsThe clinical records of all neonates seen in our prolonged jaundice clinic over an 8-month period in 2020 were retrospectively analysed. MSU samples were reviewed for significant pyuria (≥10 white blood cells per cubic millimetre) or significant organism growth (>100,000 colony-forming units). Patient records were reviewed to assess for symptoms of UTI at the time of, and shortly after, MSU sampling. Clinic notes, discharge summaries, electronic prescribing interfaces and radiology reports were analysed to establish the subsequent management and any significant sequelae.ResultsFifty-nine neonates met the inclusion criteria, of whom 57 (96.6%) had an MSU sample collected. Of these, 10 (17.5%) had single organism growth, 5 (8.8%) had mixed growth, and 42 (73.7%) had no growth. No patients with mixed growth met the criteria for diagnosis of a UTI as defined by NICE guidelines. The incidence of significant growth in neonates attending the prolonged jaundice clinic was 17.5% locally, compared to 0.21% reported in the literature.All 10 samples that cultured an isolated organism had growth >100,000 colony-forming units. Organisms included Coliform Species (40%), E. Coli (20%), Enterobacter Cloacae (20%), Enterococcus (10%), and Group B Streptococcus (10%). Two (20%) also had significant pyuria. Records showed that 4 (40%) of the patients with isolated organism growth were treated with antibiotics.Of the 6 patients (60%) with single organism growth that did not receive antibiotics, none developed symptoms of a UTI or required admission. Three (30%) had a repeat MSU sample, all of which showed no growth.ConclusionsWithin our sampled population there was a significantly higher number of positive urine cultures in neonates attending the prolonged jaundice clinic compared to published rates. The management of patients with significant single organism growth was variable, and in most instances was not in line with current NICE guidance. Despite this, we found no significant illness or admission to hospital in patients with positive MSUs who were not treated with antibiotics.It remains unclear if a proportion of neonates with single organism growth may represent contamination or asymptomatic bacteriuria. Further research is required to establish the risk of significant single organism growth in neonates presenting with isolated prolonged jaundice.

• Publisher: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health,BMJ Publishing Group LTD
• Subject: Abstracts / Antibiotics / Asymptomatic / Bacteriuria / Cell culture / Clinical Diagnosis / Colonies / Complications / Computerized physician order entry / Contamination / Diagnosis / E coli / Interfaces / Jaundice / Leukocytes / Morbidity / Neonates / Patients / Pediatrics / Pyuria / Radiology / Records (Forms) / Streptococcus infections / Urinalysis / Urinary tract / Urinary tract infections / Urine