Root Cause analysis a must for Urinary infections in Children: Dr Saumil Gaur

In the Covid season, whenever a kid gets fever, parents are worried whether the kid has been infected with Covid. In fact, fever may not just be a symptom of Covid but can also be of Urinary Tract Infection (UTI). Doctors have observed that many kids not only suffer UTI once but multiple times in a year if it is not properly treated. 

 Urinary infections in children are the most common infections during childhood. A large number of children attend hospitals and clinics before 5-6 years of age for urinary infections. Deeksha (2.5years) old girl child is one of such children who developed three urinary infections in the last one year. Now her parents are confused and worried. Each time she developed high grade fevers along with vomiting and irritability. Parents are not sure of the reason and don’t know how to approach it.
In another case, 10-month old Sugandha (name changed) developed high fever for three days. She was evaluated by her neighbourhood medical practitioner and urine examination revealed infection in urine. She was treated with oral syrups and she became better by 3-4 days and life moved on. However two weeks later, she again developed a urine infection with a fever. She had two more such UTIs till three years of age when she was detected to have underlying kidney disease. But by this time her kidneys had developed scarring and had low functionality.
Such are the stories of many small children who developed urinary infections. Urinary Tract Infections (UTI) are one of the most common causes of fever in children below 5 years of age. They are also very common in older children and adults especially teenage girls and middle aged women. Urinary infections can lead to major long term consequences in the kidneys of children as they grow and sometimes may lead to deterioration of kidney functions too.
 Each episode of UTI must be followed by a deeper Root Cause Analysis by Paediatric Nephrologists who are Paediatricians trained in Kidney Diseases of Children. The aim is to prevent permanent damage in the kidneys of children.  At Rainbow Children’s Hospital, all children who are admitted with UTI are attended by a Paediatric Nephrology team who do deep root cause analysis of each case. During the last 3 years, around 685 children below 5 years of age were admitted with urinary infections in Paediatric nephrology unit of Rainbow Children’s Hospital and underwent analysis. It was revealed that around 41 pc of such children had Vesicoureteric reflux which was subsequently treated successfully in almost all children. 
 Urinary infections should be seen as potential damaging infections in children below 5 years of age. They can swell kidneys, give rise to high WBC count, High CRP levels and make children sick with high fever and vomiting along with poor feeding. In such scenarios urinary infections should be treated with injection antibiotics for a proper duration of 5-7 days. However, mild urinary infections in children more than 5years of age can be treated with oral antibiotics only. 
Prevention of Urinary infection in children: Certain precautions like preventing constipation and preventing postponing of urine for long hours are paramount. Liberal fluids intake, maintaining genital hygiene and regular diet helps to a great extent. 
Urinary infections don’t occur by using public/common toilets or by using Diapers as it is usually thought of in the society. No scientific research has proven this connection between Diapers or public toilets. However, Diapers must be changed frequently at regular intervals. UTI is not a contagious disease in children and cannot spread by coming into contact with common wash room in schools or home. 
•        It is important to treat every single episode of urinary infection properly and completely to prevent damage to kidneys in children below 5 years of age
•        Each episode of Urinary infection must be followed with a detailed Root cause analysis to prevent another episode. 
•        Early Referral and treatment with Paediatric Nephrologists would help identify the root cause and ensure a complete treatment and analysis. 
•        It is important to take even a single episode of UTI very seriously in children.
•        UTI in children can lead to irreversible damage to kidneys.
•        Children must undergo a detailed evaluation for root cause analysis to identify and treat underlying structural abnormalities causing UTI.

Author :
Dr Saumil Gaur    MD FPN
Consultant Paediatric Nephrologists
Centre of Excellence of kidney diseases and Transplant in Children
Rainbow Children’s Hospital, Marathahalli, Bangalore

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