Neonatal Urinary Tract Infections in central Israel- Cinical Profile and Outcome

Introduction: Neonatal urinary tract infection (NUTI) might be the first sign of CAKUT (congenital anomalies of kidneys and urinary tract) with a reported 28% recurrence risk and secondary kidney damage. Highly prevalent circumcision in the Israeli population might influence NUTI profile.

Methods: Medical files of all NUTI patients hospitalized during 1.1.2014-31.5.2017 were searched for relevant data and follow-up completed by a telephone questionnaire, when needed.

Results: NUTI was diagnosed in 134 patients: 78(58%) males- 58 (76%) post-circumcision and non-E Coli-induced in 29(22%). NUTI in males vs females was diagnosed at an earlier age: 27.6±21 days (4.7-12) vs 43.4±22 (3-77) (p<0.001), was more often afebrile 15.3% vs 3.5% (p=0.02) and had more prolonged hospitalization 42.3% vs 19.6% (p=0.058), respectively. Males had significantly more renal sonographic abnormalities (hinting to CAKUT): 9(11.5%) vs 2(3.5%) (p<0.09). VCUG-diagnosed VUR identified in 7/12 (5 boys, 7 girls) of those evaluated mostly in females:72% vs 28%. Recurrent UTI occurred in 15/110 (13.6%) mostly females: 13(23%) vs 2(0.25%) (p<0.001). Most-86%- acute phase uromechanical sonographic abnormalities: hydronephrosis/hydroureter resolved during follow-up while renal parenchymal defects- persisted in most cases-8%- at similar rate in males and females.

Conclusion: NUTI in male patients (most postcircumcision) presents earlier, partly afebrile, has low recurrence rate but might imply a higher CAKUT risk. Female infants with NUTI might represent a higher risk population for later recurrence and VUR.