Paediatric illnesses
Treatment and care for urinary tract infections in infants and young children
Urinary tract infections are one of the common infections in children. However, due to the immature development of the urinary system in infants and young children, the symptoms, examinations, treatment methods, and sequelae are different from those in older children with urinary tract infections. Parents must take special care and handle them appropriately.
Infrequent nappy changes can lead to the proliferation of bacteria.
The urinary system includes the kidneys, ureters, bladder, and urethra. Most urinary tract infections are retrograde, meaning bacteria enter from the urethral opening and travel upwards against the flow of urine, causing infection. As babies and toddlers often wear nappies, their perineal area has more frequent and prolonged contact with urine and faeces. Therefore, if nappies are changed infrequently or not cleaned properly, bacteria can easily multiply, increasing the risk of urinary tract infections. Women have shorter urethras, and men's foreskins tightly cover their penises, making it difficult to clean away dirt, which can also easily lead to urinary tract infections. However, apart from hygiene and cleaning reasons, other congenital urinary system structural issues, such as a narrowed junction between the ureter and renal pelvis, duplicated ureters, or urethral obstruction caused by posterior urethral valves in children or vesicoureteral reflux, are also causes of urinary tract infections in infants. Furthermore, the symptoms of urinary tract infections in infants and toddlers differ significantly from those in adults. Infants and toddlers cannot exhibit symptoms such as frequent urination, burning during urination, bladder discomfort, or back pain due to kidney infection, as adults or older children can. Infants generally only experience persistent high fever but show no signs of respiratory or intestinal infections. Parents might notice that their baby's urine has an unusual odour or even contains blood. Affected infants may also appear irritable, cry excessively, be lethargic, and have a poor appetite due to the infection. If bacteria enter the bloodstream from the urinary system, causing sepsis, infants may experience shivering all over, and their hands and feet may become abnormally cold due to poor circulation. In severe cases, they may become unconscious and develop seizures.
Checks and treatment methods differ from older children.
Regarding examination and treatment, there are also differences. Due to more obvious symptoms, older children, such as those aged three or four, if they have a urinary tract infection, generally only require a mid-stream urine sample (i.e., discarding the first and last parts of the urine) for routine urine analysis and bacterial culture. Treatment involves prescribing appropriate oral antibiotics based on the laboratory results. However, the examination methods and items for infant urinary tract infections are different. Since accurate detection of whether they have a urinary tract infection is necessary, urine samples are particularly important. The method of using a urine bag to collect urine from infants may affect the laboratory results due to contamination from bacteria on the skin. Therefore, to accurately diagnose a urinary tract infection, it is necessary to insert a urinary catheter into the baby to collect urine directly from the bladder, bypassing the skin (Urinary Catheterization); or to draw urine directly from the bladder by inserting a needle through the suprapubic bone on the abdomen (Suprapubic Tap). Treatment requires intravenous antibiotics, and after the condition is controlled and the fever subsides, oral antibiotics will be used. The general course of treatment is 10 to 14 days.
Because there is a higher chance of infants having congenital abnormalities in the urinary tract, kidney and bladder ultrasounds are required. If an infant suffers from recurrent urinary tract infections more than once, the infant will need to undergo a micturiting cystogram and a DMSA scan to rule out any sequelae of kidney scarring caused by urinary tract infections.
Vesicoureteric reflux is the most common congenital anomaly of the urinary system, mainly caused by the thinness of the detrusor muscle of the bladder trigone and the intravesical ureter. It is generally divided into five grades to distinguish the severity of kidney damage, with grade five being the most severe. If an infant has grade two, they will require long-term daily administration of a lower dose of antibiotics for preventative purposes and regular follow-up examinations. Most cases can resolve on their own, but if grade five is reached, ureteroneocystostomy surgery is required to correct the reflux and prevent repetitive infections from causing permanent damage to the infant's developing kidneys.
Source: Health Wealth Creation
