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UTI in Children. NICE Guidelines Mary Conroy. Common condition May present with non specific symptoms Sequelae, heavy burden on NHS. Diagnosis < 3 months. Fever Vomiting Lethargy Poor feeding/FTT Abdominal pain /jaundice/haematuria/offensive urine. Preverbal Fever Abdominal/loin pain

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uti in children

UTI in Children

NICE Guidelines

Mary Conroy

slide2
Common condition
  • May present with non specific symptoms
  • Sequelae, heavy burden on NHS
diagnosis 3 months
Diagnosis < 3 months
  • Fever
  • Vomiting
  • Lethargy
  • Poor feeding/FTT
  • Abdominal pain /jaundice/haematuria/offensive urine
diagnosis 3 months4
Preverbal

Fever

Abdominal/loin pain

Vomiting

Lethargy

FTT

Haematuria

Offensive urine

Verbal

Frequency

Dysuria

Dysfunctional voiding

Changes to continence

Pain

Cloudy/offensive urine

Diagnosis > 3 months
when to test urine
When to test urine
  • with symptoms and signs of UTI
  • with unexplained fever of 38°C or higher (test urine after 24 hours at the latest).
  • with an alternative site of infection but who remain unwell (consider urine test after 24 hours at the latest).
collecting the urine sample
Collecting the urine sample
  • A clean catch urine sample is the recommended method for urine collection.
  • – use other non-invasive methods such as urine collection pads.
  • – do not use cotton wool balls, gauze or sanitary towels.
  • If other non-invasive methods are not possible:
  • – use a catheter sample or suprapubic aspiration
  • Do not delay treatment if the sample cannot be obtained and the infant or child is unwell
slide7
Under 3/12 0 refer to paeds
  • 3/12 – 3 years – urgent miscroscopy and culture + Abx or MC&S + Abx
management
Management
  • Under 3/12 refer
  • Upper UTI/Pyelonepritis, consider referral

Cef or Augmentin 7-10 days

  • Lower UTI, oral antibiotics 3 days eg trimethoprim, nitrifurantoin, amoxicillin
prevention
Prevention
  • Hydration
  • Try not to delay voiding
  • Address dysfunctional elimination syndromes and constipation
investigation 6 12
Investigation < 6/12
  • Typical UTI (responds to Tx 48hr)

- US within 6 weeks

  • Atypical UTI/ Recurrent UTI

- US during acute infection, DMSA,

MCUG

6 12 3 years
6/12 – 3 years
  • Typical UTI – nil
  • Atypical UTI – US during acute infection

DMSA

  • Recurrent – US

DMSA

over 3 years
Over 3 years
  • Typical UTI – Nil
  • Atypical UTI – US acute
  • Recurrent UTI – US

DMSA

follow up
Follow up
  • Refer recurrent UTI and abnormal imaging
  • Renal parenchymal defects – monitor height, weight, BP and proteinuria
  • Long term follow up: bilateral renal abnormalities, impaired renal function, BP, proteinuria under paeds nephrologist to slow progression to CKD
summary
Summary
  • Consider UTI in the febrile child
  • Refer <3/12, consider in upper UTI/Atypical UTI
  • Typical UTI > 6/12 – no need for investigation
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