UTI Flashcards
How do you measure BP in children
Doppler in <5
Sphigmanometer
Oscillomerty
24 ABPM
What factors affect BP
Sex
Age
Height
How do you measure urine in children
Clean catch. = gold standard for dip MSSU for microbiology Collection pad / urine bags - if -ve fine but +Ve could be contaminated Catheter sample Suprapubic aspiration if can't get DO NOT DELAY RX
How do you Dx UTI
Clinical signs +
Bacterial culture from MSSU / clean catch
Any growth on aspiration / catheter
What are common signs in neonates of UTI
Fever
Vomiting
Lethargy
Irritable
What are common signs in children
Fever - sometimes the only sign so always exclude in child with fever Abdominal pain Vomiting Poor feeding Lethargy Irritable
What are less common signs of UTI in children
Haematuria
Offensive urine
Cloudy urine
Dysfunctional voiding / changes to continence
Increased frequency
Dysuria
Loin pain + high fever suggest pyelonephritis
What is important to remember in UTI
Can present as septic shock
Fever >38
How do you Dx UTI
Dipsick - leucocytes/ nitrites
If nitrites present = treat as UTI and send
If only leucocytes = need clinical evidence
Microscopy - pyuria >10 or bacteria
Culture >10^5 = gold standard
+SYMPTOMS
Consider FBC, CRP, CXR, throat swab if -ve
Any S+S or unexplained fever in child = urine culture / dip
What are common organisms in UTI
E.coli = most common
Klebsiella
Proteus = stag
Psuedomonas
When is VUJ more likely
Abnormal kidney
Ureter displaced laterally so urine has tendency to flow back into ureter from bladder
What do you think in children with UTI
Is the kidney abnormal
And in abnormal kidney think is there VUJ
Higher risk of CKD, scarring, chronic pyelonephritis and hypertension
What are RF for UTI
VUJ
Incomplete emptying - constipation / neuro
Poor hygiene
When do you investigate children during admission
Atypical - Sepsis - Creatinine - Mass - Poor flow - Failure to respond - Non-E.coli <6 months and recurrent <3 months = refer
When do you imagine within 6 weeks
<6 months
>6 months and recurrent
Risk of scarring / known abnormality
What is 1st line imaging
USS to show abnormality
What do you do to show VUJ / reflux
Micturating crytourethrogram
What do you do 4-6 months after
DMSA
Detects scarring
How does pyelonephritis present
Loin pain
Fever
When do you admit with UTI
<3 months = refer immediately to paeds
>3 months + upper UTI
What do you do if lower tract
3 day Ax
Analgesia
What do you do if pyelonephritis
10 day Ax
Analgesia
or
Admit
What do you advise
Bring back if unwell after 48 hours
What do you do if known abnormality
Nephrologist
What Ax
Trimethoprim
Nitrafurantoin
Co-amox
Cephalosporin if pyelonephritis
How do you prevent
Voiding advice Dont delay Regular emptying Fluid intake Laxative if constipation
What do you give prophylaxis if recurrent
Trimethoprim
What do you do if VUJ
Avoid constipation / full bladder
Prophylactic Ax
STING
Ureteric preimplantation
When would you get urine sample in a child
S+S suggestive of UTI
Unexplained high of 38+
