Lidefelt Karl-Johan, Herthelius Maria
Department of Paediatrics, Karolinska University Hospital, Stockholm, Sweden.
Pediatr Nephrol. 2008 Nov;23(11):2021-4. doi: 10.1007/s00467-008-0893-z. Epub 2008 Jun 17.
The aim of this study was to determine the occurrence of urinary tract infection (UTI) in infants with antenatal renal pelvis dilatation (ARPD). Consecutive ultrasound (US) screening of 14,000 pregnant women detected ARPD >or=5 mm in 106 foetuses. After birth, two US examinations were performed: on the fifth to seventh day and during the third week of life. The findings were considered normal when renal pelvis dilatation (RPD) was <or=7 mm on both examinations and no other signs of abnormality were present. Voiding cystourethrography (VCUG) was done in all infants 6-8 weeks after birth. One hundred and three infants were followed for 2 years. Antibacterial prophylaxis (trimethoprim 1 mg/kg per day) was given to those with RPD >or=15 mm, vesicoureteric reflux (VUR) grades III-V and suspected obstruction. In 53/103 babies, both US examinations were normal, three had VUR grade I. Two girls had UTI at 18 and 24 months of age, respectively. Among the 50 infants with abnormal initial US, six had VUR, of which four were high grade (IV-V). All four developed UTI. We conclude that UTI is uncommon in infants with two normal postnatal US examinations. Routine use of antibacterial prophylaxis in these infants therefore cannot be recommended.
本研究的目的是确定产前肾盂扩张（ARPD）婴儿中尿路感染（UTI）的发生率。对14000名孕妇进行连续超声（US）筛查，发现106例胎儿肾盂扩张≥5mm。出生后，进行了两次超声检查：出生后第五至七天和出生后第三周。如果两次检查时肾盂扩张（RPD）均≤7mm且无其他异常体征，则结果被认为正常。所有婴儿在出生后6 - 8周进行排尿性膀胱尿道造影（VCUG）。103名婴儿随访了2年。对RPD≥15mm、膀胱输尿管反流（VUR）Ⅲ - V级和疑似梗阻的婴儿给予抗菌预防（甲氧苄啶1mg/kg/天）。在103名婴儿中，53名婴儿的两次超声检查均正常，3名婴儿有Ⅰ级VUR。两名女孩分别在18个月和24个月时发生UTI。在最初超声检查异常的50名婴儿中，6名有VUR，其中4名是高级别（Ⅳ - V级）。这4名婴儿均发生了UTI。我们得出结论，产后两次超声检查正常的婴儿中UTI并不常见。因此，不建议对这些婴儿常规使用抗菌预防措施。
