PROLONGED JAUNDICE AS AN EARLY MANIFESTATION OF ASYMPTOMATIC URINARY TRACT INFECTION

Prolonged jaundice has been reported as a clinical sign of urinary tract infection in newborns. The aim of the present study was the evaluation of the incidence of urinary tract infection in neonates with prolonged unconjugated hyperbilirubinemia. 1244 neonates hospitalized at Ekbatan neonatal department, from September 2002 to September 2006 were evaluated in this descriptive study. The age of the neonates was 14-31 days. Term neonates with bilirubin concentration more than 16 mg/dl and preterm neonates with bilirubin more than 14 mg/dl whose icter lasted more than 14 days were in the study. Exclusion criteria were: direct bilirubin >%15 TSB; body temperature >37.5 0C; diarrhea; emesis; poor feeding and tachypnea. Urine analysis, Hb, Hct, blood group and maternal and neonatal Rh, reticulocyte count, direct coomb’s, G6PD deficiency test, T4, and TSH were done for all neonates. Suprapubic sampling was done for neonates with urinary infection. 316 neonates with prolonged unconjugated icter were evaluated; urine culture (with urine bag sampling) was positive in 36 neonates (11.4%). If the pathogen count was more than 105 colonies in the sample, suprapubic sampling was done. Suprapubic samples were positive in 21 neonates (6.6%). The most common pathogen was E.coli (80.9%). 7.6% of boys had urinary infection while 5.3% of girls had urinary infection which was not significant (P>0.05). The incidence of urinary infection in preterm neonates was significantly higher than term neonates (P<0.05). The incidence of urinary infection in low birth weight neonates was significantly higher than normal weight neonates (P<0.05). This study shows that urinary tract infection rate in neonates with prolonged unconjucated icter is 6.6%.