URINARY TRACT INFECTIONS IN CHILDREN
Urinary tract infection (UTI) is one of the most common infections in childhood. It is the second most common cause of upper respiratory tract infections. It is the infection of any part of the urinary system (kidneys, ureters and bladder) with germs, especially bacteria.
The infection is called “cystitis se only if it is located in the bladder and iyel pyelonephritis sa if it reaches the kidney. In the first year of life, it is more common in boys, especially in uncircumcised babies, while the frequency increases in later years. It is generally seen in 3-7% of girls under 5 years of age and 1-2% in boys.
WHY IS URINARY TRACT INFECTION IMPORTANT IN CHILDREN?
Urinary tract infection is usually recurrent in childhood and often has an underlying urinary tract anomaly that facilitates the development of UTI. In addition, it may cause kidney damage and cause serious problems such as high blood pressure, pregnancy problems and chronic renal failure in long-term follow-up. The risk of developing kidney damage is higher in patients who develop at an early age (especially in infancy), who are treated late and have recurrent UTIs. For all these reasons, it is very important to define the first UTI, to treat it adequately and timely and to follow it up appropriately.
HOW DOES URINARY TRACT INFECTION IN CHILDREN?
Under normal conditions, urine is sterile and contains no microorganisms. The most common agent of UTI in children is intestinal bacteria and 80-90% is caused by bacteria called Escherichia Coli (E. coli). Less frequently, other bacteria and rarely viruses and fungi also cause UTI. Bacteria that settle and proliferate around the anal and genital area enter the urinary canal, called the urethra, first reach the bladder and then the kidney, and multiply there, causing infection. Less frequently, bacteria can come directly into the urinary tract through blood or infection of neighboring organs.
INCREASING THE RISK OF URINARY TRACT INFECTION IN CHILDREN
1-Newborns and babies are prone to UTI because their immune systems are not fully developed, especially in the first months of life.
2-Because the urethra is shorter in girls, germs reach the urinary tract more easily and UTI develops more easily.
3-In uncircumcised boys, especially in the first year of life, bacteria grow more easily under the foreskin and may pass to the urinary tract and cause infection.
4-Structural disorders of the urinary system disrupt the flow of urine to facilitate the development of UTI. The most common disorder is vesicoureteral reflux (VUR), which is called urinary escape from the bladder to the kidneys. In addition, urinary stenosis and many rare renal anomalies lead to the development of UTI. For this reason, renal disorders detected by ultrasonography performed in the womb should be followed up after birth.
5-Bladder emptying of the urinary disorders or urinary problems in children who hold the urine flow slows down the bacteria can not be sufficiently cleaned and UTI can develop easily. Constipation, which disrupts the emptying of the bladder due to the pressure of the intestines, is one of the reasons facilitating the development of UTI.
WHAT ARE THE SYMPTOMS OF URINARY TRACT INFECTION?
In infants under two years of age, the findings are not specific to the disease. UTI should be investigated in every baby with high fever. The baby's intermittent urination, crying while urinating, male baby's urine can not gush, the smell of urine to be warned families are signs. However, in addition to these, prolonged jaundice, tendency to sleep, decrease in movements, crying, moodiness, restlessness, loss of appetite, malnutrition, diarrhea, vomiting, and inability to gain weight constitute the UTI symptoms.
Older children may express their complaints. In urinary tract infection, ie cystitis, symptoms such as burning while urinating, frequent urination, urgent urination, bad smelling urine, incontinence, and bloody urination are observed. Infections involving the kidney are accompanied by symptoms such as fever, vomiting, side pain, and abdominal pain. These patients may also have complaints such as growth retardation and inability to gain weight.
HOW IS THE DIAGNOSIS OF URINARY TRACT INFECTION?
The presence of white cells and bacteria in the urine test may suggest UTI. The definitive diagnosis is made by the growth of bacteria in urine culture. For the urine culture, the beginning and end of the urine is thrown out and the mid-stream urine sample is taken in older children. In children and infants who have not yet been able to tell the urine, the most commonly used method is to connect the bladder after the necessary cleaning. As this method is highly likely to contaminate, the bag should be replaced frequently. In some cases, urine can be taken from the urethra with a urinary catheter or a needle under the umbilicus to enter the bladder. Urine specimens reach the laboratory immediately, preventing the possibility of contamination and providing a more reliable result.
HOW TO TREAT AND TREAT URINARY TRACT INFECTION?
Urinary tract infection is treated with appropriate antibiotics for 7-14 days. In addition to UTI treatment in children, it is very important to examine risky patients with various imaging methods and to apply preventive treatment in order to prevent the development of new infections. Renal ultrasonography is the most commonly used method for research purposes. If necessary, urinary cystography can be performed by attaching a catheter to the bladder for VUR detection. The scintigraphic examinations performed in the departments of Nuclear Medicine can be used to investigate the damage and functions of the kidney. Adequate fluid intake and hygiene as a preventive treatment, frequent emptying of the bladder, prevention of constipation, correction of voiding disorder, if any, and circumcision of boys are recommended. Apart from these precautions, some selected patients should be put on continuous preventive antibiotic treatment.
As a result, it can be ensured that the risk of kidney damage can be minimized by the good cooperation of the family and physician, the initiation of appropriate and timely treatment, and the necessary preventive measures by taking adequate precautions in the necessary patients.
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