The baby is crying, has a fever, is not taking milk well, and the child is not coughing or gasping, let alone having diarrhea. What’s wrong? Be sure to rule out a urinary tract infection. On average, one in forty male babies under the age of one will have a urinary tract infection (2.7%), and strangely enough fewer female babies in this age group will have a urinary tract infection (0.4%). It is also possible that there is more vesicoureteral reflux in males. However, by school age children, girls have three times more urinary tract infections than boys (0.03-1.2% for boys and 1-3% for girls). It is possible that this is related to the short urethra. Most of the bacteria from feces enter the urethra and bladder from the perineum. In children with vesicoureteral reflux, bacteria are more likely to enter the kidney and cause nephritis. Some Escherichia coli (E. coli), which attach to the urethral bladder epithelium by specific bacterial hairs (pili) and umbrella hairs (fimbriae), are the most common bacteria causing urinary tract infections. Some bacteria come from the space between the foreskin and the glans. Circumcised baby boys have an exposed, drier glans and are 10-12 times less likely to have a urinary tract infection. However, I personally do not think this means that every newborn should be circumcised; my practice is to selectively circumcise those baby boys with congenital urinary tract anomalies. After puberty, girls who start having sex or become pregnant increase the chances of urinary tract infections. Why are you so nervous about urinary tract infections? Because growing kidneys are more fragile than adults,17% and a tract infection can cause permanent damage to the kidney, leaving a scar. And 10-20% of these children with scarred kidneys will have high blood pressure. This shows the seriousness of urinary tract infections. Ruling out congenital urinary tract abnormalities Unlike adults, it is important to rule out congenital urinary tract abnormalities in infants under six months of age with urinary tract infections, because the first clinical sign of many abnormalities such as hydronephrosis and vesicoureteral reflux is a urinary tract infection. If babies are infected before they are born, the probability of congenital disease is much higher than in adults. UK NICE guidelines recommend ultrasound for all babies with urinary tract infections under six weeks. For recurrent infections (second or more inflammations) or infections caused by uncommon bacteria, children should have a voiding cystourethrogram to rule out vesicoureteral reflux, posterior urethral valves or ureteral bulges, and malformations of the bladder gap chamber. An isotope renogram (DMSA) is also recommended to determine renal function and to explore the extent of renal scarring. Parents do not need to worry about isotopes, which are only one-fifth the radiation of a single X-ray. After treating these babies under six months of age, UK GPs will see a pediatric urologist to rule out congenital anomalies. The flow of water does not corrupt the household. Urological malformations prevent the complete and fluid elimination of urine, giving bacteria the opportunity to multiply. 1. Incomplete urination: a. Vesicoureteral reflux, there is always some urine reflux into the ureter or renal pelvis, and urine cannot be completely excreted. b. Repeated kidney, the upper kidney usually functions very poorly, plus the hydronephrosis, which means the urine flows very slowly, just like a stinky ditch, and it is easy to inflame. c. Neurogenic bladder, where the urethral sphincter cannot relax and urine cannot be removed from the bladder, causing chronic urine flow and reflux. d. paraureteral bladder diverticulum (Hutch diverticulum), urinary drainage is not clean. 2. Urinary obstruction: a. Pelvic ureteral interface stenosis, causing hydronephrosis b. Vesicoureteral interface stenosis, causing megaureter c. Posterior urethral valves, causing dyspareunia, neurogenic bladder, megaureter, hydronephrosis, etc. d. Ureteral bulges, whose cysts cause ureteral obstruction, and large ones may block the bladder neck and cause dyspareunia. These congenital urinary anomalies, although not present in every child, should be thoroughly examined and should not wait until there is recurrent inflammation and permanent damage to the kidney or bladder before seeing a pediatric urologist.