Corresponding Author: Moslehi Mohammad Ashkan, MD, Department of Pediatrics, Nemazee Hospital , Shiraz University of Medical Sciences, Shiraz , Iran . E-mail: moslehim@sums.ac.ir

RADIOGRAPHIC EVALUATION

Radiographic evaluation must be performed in all newborns with UTI. This evaluation includes ultrasonography and voiding cystourethrogram (VCUG). A renal ultrasound should be obtained after antibiotic treatment is initiated and the infant's clinical condition has stabilized. This examination will demonstrate the presence, position, and size of the kidney; the size and thickness of the bladder; dilation of the collecting system; and any structural abnormalities. A normal ultrasound examination does not exclude VUR or renal scarring.

• Voiding cystourethrogram A VCUG is performed to detect VUR. Performing VCUG should not be delayed in infants who have abnormalities detected on ultrasonography. Earlier examination also may be indicated in infants with abnormalities detected on antenatal ultrasound examination.
  
  Radionuclide cystography (RNC) is used by some physicians as an alternative to VCUG in children. VCUG with fluoroscopy characterizes reflux better than does RNC. VCUG also detects intrarenal reflux and provides functional and anatomic information about the bladder and urethra that cannot be obtained by RNC. For these reasons, VCUG is the preferred technique. Alternative procedures that avoid radiation exposure, such as contrast-enhanced sonography, remain under investigation.⁴⁰
 
• Other imaging Renal cortical scintigraphy (with 99 m Tc-DMSA or 99 m Tc-glucoheptonate) and enhanced computed tomography may be used to identify renal scarring and acute changes due to pyelonephritis. Cortical scintigraphy is more sensitive than is ultrasonography to detect renal changes.¹It may be considered if renal damage is suggested by ultrasonography or as part of follow-up evaluation.

OUTCOME

Many children with UTI develop renal scarring, and newborns also are likely at risk for this complication. Renal scarring may result in hypertension and chronic renal disease. In one study, renal scars were documented by follow-up scintigraphy in 40 percent of infants with UTI at less than one year of age.⁴²

In another report by the same authors; few infants in this age group with renal scarring had VUR.⁴³ Nephropathy also can be present at birth in infants with severe reflux seen on prenatal ultrasonography even without UTI.^{44, 45}

Neonatal UTI may impair renal growth. In one study, 22 children who had UTI before reaching one month of age were followed for 12 to 21 years.⁴⁶ Renal growth was decreased in patients with and without reflux at approximately four years after the UTI, although renal size tended to become normal later.

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