Urinary tract infections in babies

Urinary tract infections (UTI) are the most common cause of a bacterial infection in babies. Studies conducted in the UK show that 2.1% of girls and 2.2% of boys will have had a urinary tract infection before the age of 2 years. They happen when bacteria get through the urethra into the bladder and the kidneys. Sometimes, abnormalities of the urinary tract (the organs of the body which filter the blood to produce urine and release it) can be the cause for urinary tract infections.

What are the symptoms of a urinary tract infection in babies?

It is quite difficult to diagnose a urinary tract infection in a baby. The symptoms are often nonspecific and can include fever, vomiting, irritability and crying, poor feeding, drowsiness, poor weight gain or weight loss, and a bloody or smelly nappy.

Should I see a doctor about this?

Yes, every baby with a fever should be seen by a doctor as soon as possible. See your GP or go to A&E if out of hours. The medical team will perform tests, which include testing your little one’s urine.

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My baby was diagnosed with a urinary tract infection – what happens next?

Urinary tract infections in babies can be serious and need to be treated with antibiotics. If your baby is under 3 months old, they will most likely be admitted to the hospital and receive antibiotics, which is often done intravenously. This means the antibiotics will be injected through your little one’s veins directly into the bloodstream. Babies cannot metabolise antibiotics, which are swallowed, as well as adults can, so it is often necessary to give them intravenously. Babies older than 3 months can sometimes be treated with oral antibiotics.

Once the infection has subsided, the medical team taking care of your little one might suggest further tests. This is for two reasons: First of all, they will want to make sure that your baby’s kidneys are recovering properly from the infection. Secondly, abnormalities of the urinary tract can often be the cause for infections. It is important to look for these abnormalities as there is an increased risk for recurrent infections, if they are left untreated.

Your specialists will advise one or all of the following examinations:

Ultrasound of the kidneys and bladder

It is an easy and painless examination where your doctor will look at the size of the kidneys and look out for any abnormalities, such as urine blockages, scars or an asymmetrical growth of the kidneys.

Micturating Cystourethrogram (MCUG)

It is a special type of x-ray and looks for vesico-ureteral reflux, meaning if urine passes from the bladder back to the kidneys while your baby is weeing. Contrast dye is inserted into your little one’s bladder with a very thin catheter. The x-ray then shows what happens to the dye when your baby wees. In some babies, the dye doesn’t only flow from the bladder outside the body but also back to the kidneys, which puts these children at higher risk for urinary tract infections. Most babies will grow out of this condition but will need to be covered with a small dose of antibiotics for a longer period of time.

A DMSA (dimercaptosuccinic acid) scan

This is a test which uses a chemical (DMSA) to look for parts of your baby’s kidneys which work only a little or not at all. This can happen when the kidneys are scarred from previous infections or when one kidney hasn’t been functioning from birth because of an inborn problem. DMSA emits gamma rays, a source of radiation, which is picked up by a special camera. The picture will then show the colourful parts of your little one’s kidney which are working well and scarred or malfunctioning parts without colour uptake.

You can find more information about these tests on https://www.infokid.org.uk.

Can I prevent urinary tract infections in my baby?

Unfortunately, these infections cannot be prevented, unless the diagnosis of an abnormal urinary tract has been made before the first infection. Before your little one is born, their kidneys will be checked during your ultrasound check ups. Abnormalities of the urinary tract can sometimes be picked up during these examinations. This is not always the case so a normal ultrasound before birth doesn’t necessarily exclude the occurrence of an infection later on.

It is important that you see your doctor if your baby is unwell or has a fever. This is the best way to help your little one. Having to go to the hospital can be stressful and frightening. It can help to know that this is a rather common condition and the medical staff will make sure to help you and your little one during these difficult times.

Article by Sophie Niedermaier Patramani, Paediatrician, and MD of Little Tummy 

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