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Abstract
Aims NICE guidance on Neonatal jaundice recommends a urine culture for investigation of prolonged jaundice (PJ) and cites 1 British and 2 Turkish papers. We aimed to conduct literature review of urine cultures in babies with PJ and review our own experience from our patient population.
Methods We conducted a search using Medline and Embase for articles presenting original data for urine infections in jaundice and PJ. A retrospective review of all cases attending our outpatient department for PJ screening over the 3 year period from Jan 2010. Patients undergoing screening were identified from the laboratory database and case notes were then reviewed for results and subsequent management. Urine samples are collected in a sterile bag by a senior experienced nurse, samples are repeated at the discretion of the doctor by clean catch sample and treatment started if repeat shows pure growth and colony forming units >100,000/ml.
Results Literature review identified 17 English language articles, 6 of which looked exclusively at infants older than 14 days (Table 1). There is significant difference in reported UTI rates by country (p = 0.00005). UK UTI rates were 0.85% in all infants and 1.3% in PJ infants using pooled data. We identified 279 infants seen in our unit for PJ screening (Figure 1). Only one infant (0.35%) met our criteria for UTI.
Combined UTI data for jaundice and PJ across the world
Conclusions Reported rates of UTI in well infants with PJ differ significantly worldwide. NICE’s recommendation is based on data from 2 seperate populations with differing UTI rates. While lab costs for a urine culture are relatively cheap (approx. £11), when staff and parent time is taken into consideration costs increase substantially. Moreover the diagnostic yield is low and the recalling of infants for repeat samples causes unnecessary anxiety for parents and adds further costs. In view of our findings our unit has changed practice and no longer includes urine culture in screening of well infants referred for investigation of prolonged jaundice. We suggest that NICE reconsider the evidence when next redrafting the guidelines.