An outstanding session on "Controversies in the Diagnosis and Management of Urinary Tract Infection in Infants < 2 Months Old" was held at the Pediatric Academic Societies (PAS) 2021 Virtual Event.
The panel noted that there is an American Academy of Pediatrics Clinical Practice Guideline on the diagnosis and treatment of UTI among children 2-24 months, reaffirmed in 2016. But practitioners also have questions about the approach to febrile infants younger than 2 months and how the presence of UTI may influence diagnostic and therapeutic choices. Answering some of those questions for infants 0-2 months was the purpose of this session, focusing in particular on making the diagnosis, need for testing beyond urine, and recommendations for treatment.
Diagnosing UTI in Newborns 0-2 Months
The first question was whether the diagnosis of UTI in infants 0-2 months differs from the approaches in the guideline, which recommends that UTI diagnosis be made only when you have both a positive urine culture and evidence of infection on the urinalysis, either pyuria (> 5 WBC/hpf on centrifuged microscopy) or bacteriuria (positive leukocyte esterase or bacterial nitrite).
Dr Tom Newman, of the Stanford Department of Pediatrics, commented that it can be difficult to determine the "gold standard" for the diagnosis of UTI in infants younger than 2 months of age.
