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Urinary tract infection (UTI) in young infants is considered to be an important risk factor for acquired renal damage and scarring. Renal scars may have health consequences in later life. As a consequence, there is a belief that aggressive diagnostic workup is necessary in order to detect urinary tract malformation and vesicoureteral reflux (VUR). Different national guidelines aim to standardise diagnosis and treatment in children with UTI. Most recommend voiding cystourethrography (VCUG) in cases of abnormal ultrasound and/or atypical UTI.
However, there is no common international agreement. In addition, the implementation of guidelines is generally poor. A recent survey in Europe1 showed a huge variation in current practice in diagnosis and treatment for children with UTI. Protecting children from unnecessary diagnostic radiation exposure, the health related costs, and concerns that guidelines may miss or delay in diagnosis of clinically significant VUR all create current debate. In all of this, infants <3 months of age remain the most vulnerable patient group, deserving special attention.
Pauchard et al 2 from Switzerland have asked whether voiding cystography should be recommended in all children younger than 3 months of age. They studied children <3 months old with a first febrile UTI, excluding those with known urinary tract malformations. Urine culture was obtained by catheterisation or suprapubic aspiration. Ultrasound was performed within 6 days. VCUG was done in all infants within 2–8 weeks, in line with Swiss guidelines. Considering that high-grade reflux is expected in about 10% of patients only, they looked for predictive …
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.