PC.31 Review of urine infections in well infants investigated for prolonged jaundice (NICE guidance) – 3 year UK experience from a single tertiary neonatal unit

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Abstract

We conducted a search for articles presenting original data for urine infections in jaundice and Prolonged jaundice (PJ). A retrospective review of all cases of PJ over a 3-year period. Patients were identified from the laboratory database and case notes were then reviewed for results and subsequent management. Urine samples are collected in a sterile bag by a senior experienced nurse and treatment started if repeat shows pure growth and colony forming units >100,000/ml.

Results

We identified 17 English language articles, 6 of which looked exclusively at infants >14 days. There are significant differences in reported UTI rates by country (p = 0.00005). UK UTI rates were 0.85% in all infants and 1.3% in PJ infants using pooled data. 279 infants were seen in our unit for PJ screening, only one well infant (0.35%) met criteria for UTI.

Conclusions

NICE recommendations are based on data from 2 separate populations with differing UTI rates. While lab costs for a urine culture are relatively cheap (approx. £11), when staff and parent time is taken into consideration costs increase substantially. Moreover the diagnostic yield is low and the recalling of well infants for repeat samples causes unnecessary anxiety for parents. Our unit has changed practice and no longer includes urine cultures in PJ screening of well infants. We suggest that NICE reconsider the evidence when next updating the guidelines.

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