Urinary Tract Infection in Asymptomatic Newborns with Prolonged Unconjugated Hyperbilirubunemia: A Hospital based Observational study from Western Region of Nepal.

Background Urine culture is usually not a part of work-up for neonatal unconjugated hyperbilirubinemia; hence its prevalence remains unknown. Objective This study was done to determine the incidence of urinary tract infection (UTI) in asymptomatic newborns with prolonged unconjugated hyperbilirubinemia and to evaluate which other laboratory parameters are associated with UTIs. Method A prospective observational study where jaundiced newborns otherwise clinically well, were evaluated for UTI. The study was carried out in neonatal intensive care unit of Manipal Teaching Hospital, Pokhara from June 2012 -April 2013. The babies were divided in two groups group I- late prolonged jaundice and Group II - early physiological jaundice. Serum bilirubin, Septic screening and suprapubic urine sample analysis was performed for all subjects. Data was analyzed using SPSS version 16 and p 7lt; 0.05 was considered statistically significant. Result Of the 85 neonates, 33(38.8%) were females and 52(61.2%) males; 68(80%) were of term gestation and 17(20%) were preterms. The age at onset of jaundice for group I (n=53) was 13.6±4.88 days and for Group II (n= 32) was 5.0± 1.04 days. 11 /85 (12.9%) were diagnosed to have UTI [10 (90.9%) in group I and 1 in group II (9.01%] (p=0.04). UTI was more prevalent in group I [OR 7.20, 95% CI (0.87, 59.27)], more prevalent in male [OR 8.40, 95% CI (0.59, 74.13) and term babies of group I [OR 4.39, 95% CI (0.48, 39.82) when compared to Group II. Among other lab parameters only total WBC count was statistically significant (p=0.03). Escherichia coli was the predominant pathogen (45.45%) isolated. The sensitive antibiotics were aminoglycosides, fluroquinolones, nitrofurantoin and vancomycin and resistant antibiotics were most cephalosporins and penicillins for the isolated organisms. Conclusion The present study highlights significant association between late prolonged unconjugated hyperbilirubinemia and UTI. It is suggested that evaluation for UTI may be considered as a screening test for such cases.