Department of Pediatrics, Division of Neonatology, University of Virginia, Charlottesville, VA, USA.
Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA.
J Neonatal Perinatal Med. 2021;14(2):269-276. doi: 10.3233/NPM-200513.
Increased understanding of characteristics of urinary tract infection (UTI) among very low birthweight infants (VLBW) might lead to improvement in detection and treatment. Continuous monitoring for abnormal heart rate characteristics (HRC) could provide early warning of UTIs.
Describe the characteristics of UTI, including HRC, in VLBW infants.
We reviewed records of VLBW infants admitted from 2005-2010 at two academic centers participating in a randomized clinical trial of HRC monitoring. Results of all urine cultures, renal ultrasounds (RUS), and voiding cystourethrograms (VCUG) were assessed. Change in the HRC index was analyzed before and after UTI.
Of 823 VLBW infants (27.7±2.9 weeks GA, 53% male), 378 had > / = 1 urine culture obtained. A UTI (≥10,000 CFU and >five days of antibiotics) was diagnosed in 80 infants, (10% prevalence, mean GA 25.8±2.0 weeks, 76% male). Prophylactic antibiotics were administered to 29 (36%) infants after UTI, of whom four (14%) had another UTI. Recurrent UTI also occurred in 7/51 (14%) of infants not on uroprophylaxis after their first UTI. RUS was performed after UTI in 78%, and hydronephrosis and other major anomalies were found in 19%. A VCUG was performed in 48% of infants and 18% demonstrated vesicoureteral reflux (VUR). The mean HRC rose and fell significantly in the two days before and after diagnosis of UTI.
UTI was diagnosed in 10% of VLBW infants, and the HRC index increased prior to diagnosis, suggesting that continuous HRC monitoring in the NICU might allow earlier diagnosis and treatment of UTI.
对极低出生体重儿（VLBW）尿路感染（UTI）特征的深入了解可能会提高检测和治疗水平。对异常心率特征（HRC）的连续监测可以为 UTI 提供早期预警。
描述 VLBW 婴儿 UTI 的特征，包括 HRC。
我们回顾了 2005 年至 2010 年在两个参与 HRC 监测随机临床试验的学术中心住院的 VLBW 婴儿的记录。评估了所有尿培养、肾脏超声（RUS）和排尿性膀胱尿道造影（VCUG）的结果。分析了 UTI 前后 HRC 指数的变化。
在 823 名 VLBW 婴儿（27.7±2.9 周 GA，53%为男性）中，有 378 名获得了> / = 1 次尿培养。80 名婴儿被诊断为 UTI（≥10,000 CFU 且>五天抗生素治疗），（10%的患病率，平均 GA 25.8±2.0 周，76%为男性）。UTI 后有 29 名（36%）婴儿给予预防性抗生素治疗，其中 4 名（14%）再次发生 UTI。首次 UTI 后未接受尿路预防的 51 名婴儿中有 7 名（14%）发生复发性 UTI。78%的婴儿在 UTI 后进行了 RUS，发现了 19%的肾积水和其他主要异常。48%的婴儿进行了 VCUG，18%显示了膀胱输尿管反流（VUR）。在 UTI 诊断前后的两天内，HRC 均值显著升高和降低。
10%的 VLBW 婴儿被诊断为 UTI，HRC 指数在诊断前升高，这表明在 NICU 中进行连续 HRC 监测可能有助于更早地诊断和治疗 UTI。
