Evaluation of Urinary Tract Infection in Newborns with Jaundice in South of Iran

Background: Neonatal jaundice is clinically presented in 60% of full-term newborns. About 8% of newborns with jaundice have urinary tract infection (UTI) without any other clinical signs in favor of UTI. In present study we evaluated clinical and paraclinical data that help to rapid and early diagnosis of UTI in apparently healthy newborns with jaundice. Methods: From February to August 2006, 51 apparently healthy full-term newborns with jaundice and UTI who had been admitted for management of jaundice in Motahary hospital, Jahrom (south of Iran), were studied and compared with 56 neonates with jaundice but without UTI. All the neonates had not any other symptoms such as fever or lethargy. At the time of admission, total and direct bilirubin, Coombs' test, mother and neonate blood group, urinalysis and urine culture were requested. Results: There was no significant difference of gestational age, birth weight, age of admission, age at the time of starting jaundice, and total serum bilirubin between the two groups. There was significant difference of direct bilirubin level, mean of decrease serum bilirubin after 24 hours, gender, and blood groups. Male gender with mean decrease of bilirubin less than 2.2 mg/dl after 24 hours phototherapy and direct bilirubin more than 1.6 mg/dl ,during the first two weeks of neonatal period has about 7 times more risk for UTI. The presence of those three above mentioned factors had only 30% sensitivity and more than 94% specificity for suspicious of UTI in asymptomatic neonates with jaundice. Conclusion: Jaundice may be the only presenting sign of UTI in newborns, so according to high specificity for the presence of three below factors simultaneously, it seems better to evaluate newborns for UTI if they have high level of direct bilirubin (more than 1.6 mg/dl), slow decrease in serum bilirubin level with phototherapy (less than 2.2mg/dl/day) especially in male newborn with blood group B