Urinary tract infections are common in infants, with 16% of children with emergency fever having a urinary tract infection. On average, this is about one in a hundred children (under one year old: 2.7% of boys and 0.4% of girls). At this age, babies can’t express themselves, so how do they know it’s a urinary tract infection?
1. Medical history and symptoms
The mother or the elderly or aunt with the baby may find that the child is irritable, does not take milk well, or even spits up milk. Sometimes the fever lasts for two days or less. The child does not have a cough or shortness of breath (pneumonia), nor does he or she have diarrhea (gastroenteritis), and cannot explain why the child is like this.
A talking child may also tell you that it hurts to pee, that his tummy hurts, or that his back hurts. Those with children may notice that the child is urinating urgently, frequently, and see that the urine is cloudy and “smelly”. Doctors should be aware that post-pubertal girls may start having sex or even become pregnant, which may increase the chances of urinary tract infections (STDs should be considered as well). The prenatal ultrasound should be carefully checked for hydronephrosis (and other urinary malformations) and spina bifida (leading to neurogenic bladder).
2. Physical examination
Many children have no special physical signs. Some just have a high fever. However, the child’s abdomen should be systematically examined for hydronephrosis, bladder (neurogenic bladder), tumors, or feces in the sigmoid colon (constipation is one of the causes of the elimination syndrome). The sacrum (spina bifida) should also be examined for hairs, sinuses, and lipomas. Lower limbs, anus for normal nerve development. Boys should be checked for paronychia.
3.Urine collection
Depending on the degree of suspicion for the diagnosis of urinary tract infection. Four types of urine collection methods are listed below. The first two are used if you just want to exclude urinary tract infection (which is unlikely), while the last two should be used if you have high suspicion of urinary tract infection and want to know clearly the nature of the bacteria and their drug resistance.
(1) Urine bag
Bring a small plastic bag on the penis or on the girl’s pubic area and take some urine. An easy routine urine test and microscopic examination can be done. Urine routine can usually be done in a few minutes with reagent strips. The most important indicators are white blood cells and nitrites . White blood cells are a reflection of all inflammation in the body. Nitrates from food can be converted to nitrites by bacteria in the bladder. If both white blood cells and nitrites are positive, 96% are urinary tract infections and antibiotics can be prescribed. If both are negative, then it should not be an infection. What if the white blood cells are positive and the nitrites are negative? If the child is asymptomatic, you should wait for the results of the urine culture and not use antibiotics. If the white blood cells are negative and the nitrites are positive, it is usually recommended to give antibiotics first.
(2) Middle segment urine
Mid-segment urine has much less chance of contamination than urine bags. Urine culture results are more reliable in boys and may still be contaminated in girls.
(3) Intubation for urine
The urine collected by this method of inserting a tube from the urethra into the bladder is more reliable for urine culture results. Of course, the child is a little uncomfortable during the urine retrieval process.
(4) Cystocentesis
This is the most accurate method. It requires a full bladder, and no child in the world would like to have a needle in the pubic bone.
4.Microscopic examination
Under a high-powered microscope (450-570x) if there are more than 30,000 bacteria per milliliter of urine, or 10 white blood cells, then a urinary tract infection can be identified.
5.Urine culture
100,000 units of CFU bacteria per milliliter of urine is the traditional gold standard for urinary tract infections.
6.Treatment
The treatment of urinary tract infections is now very standardized and once the diagnosis is established, treatment should not be a problem.