Category Archives: Pediatrics

Pediatric UTI

AAP Guideline on Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months

UK NICE guideline: Urinary tract infection in children

Summary:

  • For children with fever, UTI should be suspected.
  • For children at a very low risk for UTI, or greater than 3 years of age, a bag urine for urinalysis is an appropriate first step. If the urinalysis is suspicious for UTI, such as being positive for leukocyte esterase or nitrite, or if the children is not at a very low risk for UTI, then a catheterized urine sample should be obtained for urine culture prior to starting empiric antibiotics.
  • If the culture comes back negative, then antibiotics treatment covering UTI can be stopped.
  • Febrile UTI is presumed to be pyelonephritis, and should be investigated with Bladder and Renal Ultrasound. If the ultrasound shows structural abnormalities, or if the child has recurrent febrile UTIs, a VCUG should be considered, especially in younger children.

 

Pediatric Fever


The bulk of this episode is based on the UK NICE guideline: Feverish illness in children under 5, published in 2013. http://guidance.nice.org.uk/CG160

The guideline covers:

The Traffic Light System in assessing risk for serious infection

This assessment tool takes into consideration color/appearance, activity, respiratory, circulation and hydration, and “other” parameters. For each parameter, their associated signs and symptoms are assigned a color code: “green” (low risk), “amber” (intermediate risk) and “red” (high risk). The table can be found here.

Age-appropriate investigations for pediatric fever

Once the risk for serious infection is determined, the following investigation should be performed:

Age CBC diff BC CRP UA/UC LP CXR Stool culture
<1mo yes yes yes yes yes if indicated if indicated
1-3mo yes yes yes yes if unwell, or WBC >15 or <5M/mL if indicated if indicated
>=3mo, RED yes yes yes yes yes yes if indicated
>=3mo, AMBER yes yes yes yes if <1yr if fever >39 and WBC >20 if indicated
>=3mo, GREEN no no no yes no no if indicated

And at the same time, empiric parenteral antibiotic coverage for meningitis (3rd generation cephalosporin plus ampicillin/amoxicillin) should be started if LP is indicated.