IT will come as quite a shock to some parents when the paediatrician tells them that their child has a urinary tract infection (UTI), since the condition is most commonly seen in adults. However, paediatrician Dr Anona Griffith says that this misconception can thwart early detection, which may have serious repercussions if it goes undetected and untreated.
“Urinary tract infections are bacterial infections that occur in people of any age group, including infants, and are generally caused by bacteria entering the bladder, then the kidneys,” Dr Griffith said.
She explained that the urinary system has its own methods of preventing infection from occurring along the tract, but these defence mechanisms can become overwhelmed by bacteria, thereby producing an infection.
The condition, which she said is often caused by bacteria found in the stool, may develop in both males and females, but is more frequently seen in females because the vagina is structured in a way which makes it easier for bacteria to enter the urinary tract.
She also notes that children with some existing conditions may be predisposed to developing UTIs, including those with structural abnormalities of the urinary tract, as occurs with a posterior urethral valve.
“A posterior urethral valve prevents complete emptying of the bladder. It is a condition seen in males and is thought to be a structural complication of the male urogenital system. Backflow of urine from the bladder into the tubes that connect it to the kidneys puts babies at further risk for infection to spread to the kidneys, and this can lead to scarring of the organs that will contribute to hypertension and kidney failure later on in life. Constipation, difficulty voiding, and prolonged urinary retention are also conditions that can precipitate UTIs,” Dr Griffith said.
She said that children with UTIs can present with a number of symptoms including:
•Pain on passing urine
•Lower abdominal pain
•Change in the colour of urine (cloudy)
•Increase in the frequency of passage of urine, but with a decrease in quantity.
In small babies, the symptoms may be nonspecific or non-localising such as fever, crying, fussiness on passing urine, vomiting and diarrhoea.
Dr Griffith advised that any baby under three months that presents with a fever and non-localising symptoms must be investigated for a UTI, and if this is not done, then it should be requested in order to prevent complications.
The investigation for a UTI is usually carried out by way of a urine culture using an appropriately collected sample — a decision which is made depending on the age of the child. Dr Griffith said that a urine dipstick or urinalysis provides supportive information, but it is not definitively diagnostic.
“Treatment protocols and recommendations have been adapted and developed for the Jamaican setting by local paediatric nephrologists and surgeons based on studies done on the Jamaican paediatric population. For young babies and infants in whom a complicated UTI is suspected, admission to hospital is usually required, and treatment is started using intravenous antibiotics that cover the more common organisms that cause UTIs.”