Abstract

 
 
 
 Background: Recent retrospective studies suggest irrelevance of urine screening for neonate with prolonged jaundice. We re-evaluated the incidence of urinary tract infection (UTI) among these infants, their renal outcome and evaluated the cost incurred. Methods: This is a prospective cohort study. Asymptomatic, prolonged jaundiced infants with unconjugated hyperbilirubinemia were screened for evidence of UTI as per local guidelines. Infants with pyuria would have urine sent for culture and sensitivity. Unit cost was referenced from hospital purchase. Statistical analysis was performed using SPSS 24.0. Results: A total of 291 cases were analyzed. Majority were term infants (93.8%). The commonest cause of prolonged jaundice was breast milk jaundice, hence an incidence rate of 0.34%. Only one infant persistently showed single uropathogen on urinary culture with concurrent pyuria. Urinary structures were normal on ultrasonography and there was no evidence of renal cortical scarring. No recurrence of UTI documented in the first year of life. Each “clean-catch” urinalysis costed RM7. This unit cost escalated to RM37 for catheterized sample. A negative urine culture costed RM28 while a positive culture twice this price. The average cost effectiveness ratio (ACER) in this study was RM5856.56 per detection of case. Conclusion: Incidence of UTI is low. In our study, an undesirable outcome is negligible. Unnecessary parental anxiety from the potentially laborious procedure could be avoided. This study refutes previous literature to include such screening in prolonged jaundice as this may well be irrelevant.
 
 
 
Highlights
Urinary tract infection (UTI) has been cited as a cause of prolonged jaundice in infants
The present study evaluate the incidence of urinary tract infection (UTI) among infants with prolonged jaundice in a developing country, underlying congenital abnormalities of the kidney and urinary tract (CAKUT) and subsequent renal scarring among newborns who screened positive
Exclusion criteria set for the study were infants with fever, irritability, history of poor feeding or any other clinical features of possible sepsis at presentation or became unwell within 72 hours of presentation, infants with poor weight gain [9], infants with concomitant dysmorphism, infants who were admitted for other medical indications and went on to develop jaundice that persisted beyond days 14 or 21, whichever applicable and infants with prolonged jaundice secondary to a surgical cause such as biliary atresia
Summary
Urinary tract infection (UTI) has been cited as a cause of prolonged jaundice in infants. In two separate retrospective studies, English researchers quoted low UTI rate and advocated for the exclusion of UTI screening that has been imposed on otherwise well infants with prolonged jaundice [7,8]. Findings from the latter studies are promising but it is not uncommon that retrospective studies could be limited by a lack of standardization and missing data. The present study evaluate the incidence of UTI among infants with prolonged jaundice in a developing country, underlying congenital abnormalities of the kidney and urinary tract (CAKUT) and subsequent renal scarring among newborns who screened positive. Costs of the present screening procedures were evaluated
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