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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

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Uti in children l.jpg

UTI in Children

NICE Guidelines

Mary Conroy


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  • Common condition

  • May present with non specific symptoms

  • Sequelae, heavy burden on NHS


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Diagnosis < 3 months

  • Fever

  • Vomiting

  • Lethargy

  • Poor feeding/FTT

  • Abdominal pain /jaundice/haematuria/offensive urine


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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


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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).


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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


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  • Under 3/12 0 refer to paeds

  • 3/12 – 3 years – urgent miscroscopy and culture + Abx or MC&S + Abx


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Microscopy


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Urine dipstick


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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


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Prevention

  • Hydration

  • Try not to delay voiding

  • Address dysfunctional elimination syndromes and constipation


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Investigation < 6/12

  • Typical UTI (responds to Tx 48hr)

    - US within 6 weeks

  • Atypical UTI/ Recurrent UTI

    - US during acute infection, DMSA,

    MCUG


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6/12 – 3 years

  • Typical UTI – nil

  • Atypical UTI – US during acute infection

    DMSA

  • Recurrent – US

    DMSA


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Over 3 years

  • Typical UTI – Nil

  • Atypical UTI – US acute

  • Recurrent UTI – US

    DMSA


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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


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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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