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To track the clinical evolution of febrile urinary tract infection (UTI) diagnosed in 0- to 3-month-old infants and characterize uropathogen frequencies, antimicrobial resistance rates, renal abnormalities, and differences in the sexes in this age group.We observed prospectively 46 infants identified in a cohort of 209 children with first UTI diagnosed between July 2006 and July 2008 at the age of 0 to 3 months. Renal ultrasound scanning and voiding cystourethrography examinations were performed in all infants.Infants3 months old represented 21% of all children with first UTI. Of these children, 26% were female and 74% were male. Escherichia coli was isolated in 88% of cases and had a high rate of resistance to ampicillin (71%) and to trimethoprim/sulfamethoxazole (47%); 21% of children had vesicoureteral reflux, which was of low-grade in 67% of cases, with spontaneous resolution before 2 years in all cases. In infants with normal ultrasound scanning results, a low-grade vesicoureteral reflux was subsequently found in 10% of cases.Infants aged 0 to 3 months represent 21% of children treated for febrile UTI. Boys represent 74% of these cases. E coli is responsible for 88% of UTIs, with a high rate of resistance to antibiotics. When ultrasound scanning examination results are normal, the risk of missing a significant renal abnormality is expected to be extremely low.

Objectives To determine if two successive ultrasound examinations could rule out the presence of clinically significant contralateral anomalies in neonates with multicystic dysplastic kidney (MCDK), thereby avoiding unnecessary voiding cystourethrography (VCUG). Study design We followed 76 newborn infants with antenatally discovered MCDK. Two successive neonatal renal ultrasound examinations were performed, one within the first week and one at around 1 month of life. VCUG and isotopic studies were performed in all infants. Results Urologic anomalies of the contralateral kidney were present in 19 of 76 children (25%): vesicoureteral reflux (VUR) in 16 (21%), ureteropelvic junction obstruction in 2 (3%), and renal duplex kidney in 1 (1%). Sixty-one infants (80% of total) had normal contralateral urinary tract on the 2 successive neonatal renal ultrasound scans. Among them, 4 of 61 (7%) infants presented with low-grade VUR on VCUG that had resolved spontaneously before 2 years of age. The sensitivity, specificity, positive predictive value, and negative predictive value of two successive ultrasound scans in the neonatal period to predict contralateral urological anomalies on VCUG were 75%, 95%, 80%, and 93%, respectively. Conclusions In infants with antenatally diagnosed MCDK, two successive normal neonatal renal ultrasound scans will rule out clinically significant contralateral anomalies, thereby rendering the need for a neonatal VCUG unnecessary.

Objectives: To assess the yield of neonatal renal ultrasonography as a predictor of abnormalities on voiding cystourethrography (VCUG). Study design: We prospectively followed 264 infants with antenatal renal pelvis dilation. Two successive neonatal renal ultrasound examinations were performed at day 5 and 1 month after birth. VCUG was performed in all infants. Results: Neonatal ultrasound findings were abnormal in 190 infants (72% of total). Among them, 63 (33%) had an abnormal VCUG. The most common abnormalities were primary vesico-ureteral reflux (VUR) in 30 infants, VUR into the lower pole of a duplex kidney in 14, refluxing megaureter in 9, posterior urethral valves in 5, and ureterocele in 5. When both neonatal ultrasound findings were normal (74 infants), the VCUG showed abnormalities in only 5 (6.7%) patients (4 low-grade primary VUR and 1 posterior urethral valve). The sensitivity, specificity, positive predictive value, and negative predictive value of 2 successive ultrasound scans in the neonatal period to predict an abnormality on VCUG were 93%, 35%, 33%, and 93%, respectively. Conclusions: A normal-appearing urinary tract on 2 successive neonatal ultrasound scans rarely coexists with abnormal findings at VCUG. Therefore, in such patients, VCUG does not seem justified. (J Pediatr 2002;141:21-4)