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  • 1
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    Bacteraemic urinary tract infection: management and outcomes in young infants
    BMJ ; 2016
    In:  Archives of Disease in Childhood Vol. 101, No. 2 ( 2016-02), p. 125-130
    Details
    In: Archives of Disease in Childhood, BMJ, Vol. 101, No. 2 ( 2016-02), p. 125-130
    Abstract: To determine predictors of parenteral antibiotic duration and the association between parenteral treatment duration and relapses in infants 〈 3 months with bacteraemic urinary tract infection (UTI). Design Multicentre retrospective cohort study. Setting Eleven healthcare institutions across the USA. Patients Infants 〈 3 months of age with bacteraemic UTI, defined as the same pathogenic organism isolated from blood and urine. Main outcome measures Duration of parenteral antibiotic therapy, relapsed UTI within 30 days. Results The mean (±SD) duration of parenteral antibiotics for the 251 included infants was 7.8 days (±4 days), with considerable variability between institutions (mean range 5.5–12 days). Independent predictors of the duration of parenteral antibiotic therapy included (coefficient, 95% CI): age (−0.2 days, −0.3 days to −0.08 days, for each week older), year treated (−0.2 days, −0.4 to −0.03 days for each subsequent calendar year), male gender (0.9 days, 0.01 to 1.8 days), a positive repeat blood culture during acute treatment (3.5 days, 1.2–5.9 days) and a non- Escherichia coli organism (2.2 days, 0.8–3.6 days). No infants had a relapsed bacteraemic UTI. Six infants (2.4%) had a relapsed UTI (without bacteraemia). The duration of parenteral antibiotics did not differ between infants with and without a relapse (8.2 vs 7.8 days, p=0.81). Conclusions Parenteral antibiotic treatment duration in young infants with bacteraemic UTI was variable and only minimally explained by measurable patient factors. Relapses were rare and were not associated with treatment duration. Shorter parenteral courses may be appropriate in some infants.
    Type of Medium: Online Resource
    ISSN: 0003-9888 , 1468-2044
    URL: Article
    DOI: 10.1136/archdischild-2014-307997
    Language: English
    Publisher: BMJ
    Publication Date: 2016
    detail.hit.zdb_id: 1481191-1
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  • 2
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    A Clinical Prediction Rule for Rebound Hyperbilirubinemia Following Inpatient Phototherapy
    American Academy of Pediatrics (AAP) ; 2017
    In:  Pediatrics Vol. 139, No. 3 ( 2017-03-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 139, No. 3 ( 2017-03-01)
    Abstract: The American Academy of Pediatrics provides little guidance on when to discontinue phototherapy in newborns treated for hyperbilirubinemia. We sought to develop a prediction rule to estimate the probability of rebound hyperbilirubinemia after inpatient phototherapy. METHODS: Subjects for this retrospective cohort study were infants born in 2012 to 2014 at ≥35 weeks’ gestation at 16 Kaiser Permanente Northern California hospitals who received inpatient phototherapy before age 14 days. We defined rebound as the return of total serum bilirubin (TSB) to phototherapy threshold within 72 hours of phototherapy termination. We used stepwise logistic regression to select predictors of rebound hyperbilirubinemia and devised and validated a prediction score by using split sample validation. RESULTS: Of the 7048 infants treated with inpatient phototherapy, 4.6% had rebound hyperbilirubinemia. Our prediction score consisted of 3 variables: gestational age & lt;38 weeks (adjusted odds ratio [aOR] 4.7; 95% confidence interval [CI] , 3.0–7.3), younger age at phototherapy initiation (aOR 0.51 per day; 95% CI, 0.38–0.68), and TSB relative to the treatment threshold at phototherapy termination (aOR 1.5 per mg/dL; 95% CI, 1.4–1.7). The model performed well with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.86–0.91) in the derivation data set and 0.88 (95% CI, 0.86–0.90) in the validation data set. Approximately 70% of infants had scores & lt;20, which correspond to a & lt;4% probability of rebound hyperbilirubinemia. CONCLUSIONS: The risk of rebound hyperbilirubinemia can be quantified according to an infant’s gestational age, age at phototherapy initiation, and TSB relative to the treatment threshold at phototherapy termination.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2016-2896
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2017
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  • 3
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    Urinary Imaging Findings in Young Infants With Bacteremic Urinary Tract Infection
    American Academy of Pediatrics (AAP) ; 2016
    In:  Hospital Pediatrics Vol. 6, No. 11 ( 2016-11-01), p. 647-652
    Details
    In: Hospital Pediatrics, American Academy of Pediatrics (AAP), Vol. 6, No. 11 ( 2016-11-01), p. 647-652
    Abstract: To describe renal ultrasound (RUS) and voiding cystourethrogram (VCUG) findings and determine predictors of abnormal imaging in young infants with bacteremic urinary tract infection (UTI). METHODS: We used retrospective data from a multicenter sample of infants younger than 3 months with bacteremic UTI, defined as the same pathogenic organism in blood and urine. Infants were excluded if they had any major comorbidities, known urologic abnormalities at time of presentation, required intensive unit care, or had no imaging performed. Imaging results as stated in the radiology reports were categorized by a pediatric urologist. RESULTS: Of the 276 infants, 19 were excluded. Of the remaining 257 infants, 254 underwent a RUS and 224 underwent a VCUG. Fifty-five percent had ≥1 RUS abnormalities. Thirty-four percent had ≥1 VCUG abnormalities, including vesicoureteral reflux (VUR, 27%), duplication (1.3%), and infravesicular abnormality (0.9%). Age & lt;1 month, male sex, and non–Escherichia coli organism predicted an abnormal RUS, but only non-E coli organism predicted an abnormal VCUG. Seventeen of 96 infants (17.7%) with a normal RUS had an abnormal VCUG: 15 with VUR (Grade I–III = 13, Grade IV = 2), 2 with elevated postvoid residual, and 1 with infravesical abnormality. CONCLUSIONS: Although RUS and VCUG abnormalities were common in this cohort, the frequency and severity were similar to previous studies of infants with UTIs in general. Our findings do not support special consideration of bacteremia in imaging decisions for otherwise well-appearing young infants with UTI.
    Type of Medium: Online Resource
    ISSN: 2154-1663 , 2154-1671
    URL: Article
    DOI: 10.1542/hpeds.2015-0229
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2016
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  • 4
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    The effect of hospital phototherapy on early breastmilk feeding
    Wiley ; 2021
    In:  Paediatric and Perinatal Epidemiology Vol. 35, No. 6 ( 2021-11), p. 717-725
    Details
    In: Paediatric and Perinatal Epidemiology, Wiley, Vol. 35, No. 6 ( 2021-11), p. 717-725
    Abstract: The effect of phototherapy on breastmilk feeding is unclear. Objective To estimate the effect of inpatient phototherapy on breastmilk feeding at 2‐month well‐child visits. Methods We performed a retrospective cohort study using electronic health record data. From births at 16 Kaiser Permanente Northern California hospitals (2013–2017), we identified a cohort of infants ≥ 35 weeks’ gestation with total serum bilirubin levels close to the American Academy of Pediatrics 2004 phototherapy threshold during their birth hospitalisation. We compared self‐reported breastmilk feeding at 2‐month well‐child visits among those who had and had not received birth hospitalisation phototherapy, adjusting for bilirubin levels and other confounding variables. We used multiple imputation (K = 200) to address missing data. Results Approximately a quarter of infants in the cohort (24.5%) received phototherapy during their birth hospitalisation. At the 2‐month visit, exclusive breastmilk feeding was less common (RR 0.91, 95% interval [CI] 0.88, 0.95) among those who received phototherapy (41.3%) than those who did not (45.2%). However, no association remained after adjusting for potential confounders (RR 0.99, 95% CI 0.95, 1.04; average treatment effect on the treated [ATET] −0.2%, 95% CI −2.0%, 1.5%). In contrast, any breastmilk feeding was similar between infants who did (76.8%) and did not get phototherapy (77.9%). After adjusting for confounders, phototherapy had a slightly positive association with any breastmilk feeding at 2 months (RR 1.02, 95% CI 1.00, 1.04). Among infants who received phototherapy, the proportion being fed any breastmilk at the 2‐month visit was an estimated 1.6 percentage points higher than it would have been if they had not received phototherapy (ATET 1.6%, 95% CI 0.1%, 3.1%). Multiple imputation results were similar. Conclusions Birth hospitalisation phototherapy can be delivered in a way that does not adversely affect breastmilk feeding at 2 months.
    Type of Medium: Online Resource
    ISSN: 0269-5022 , 1365-3016
    URL: Issue
    URL: Article
    DOI: 10.1111/ppe.v35.6
    DOI: 10.1111/ppe.12794
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2008566-7
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  • 5
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    Frequency of Treatment Failure of UTIs in Children With Congenital Urinary Tract Anomalies
    American Academy of Pediatrics (AAP) ; 2024
    In:  Hospital Pediatrics Vol. 14, No. 3 ( 2024-03-01), p. 189-196
    Details
    In: Hospital Pediatrics, American Academy of Pediatrics (AAP), Vol. 14, No. 3 ( 2024-03-01), p. 189-196
    Abstract: Children with certain congenital anomalies of the kidney and urinary tract and neurogenic bladder (CAKUT/NGB) are at higher risk of treatment failure for urinary tract infections (UTIs) than children with normal genitourinary anatomy, but the literature describing treatment and outcomes is limited. The objectives of this study were to describe the rate of treatment failure in children with CAKUT/NGB and compare duration of antibiotics between those with and without treatment failure. METHODS Multicenter retrospective cohort of children 0 to 17 years old with CAKUT/NGB who presented to the emergency department with fever or hypothermia and were diagnosed with UTI between 2017 and 2018. The outcome of interest was treatment failure, defined as subsequent emergency department visit or hospitalization for UTI because of the same pathogen within 30 days of the index encounter. Descriptive statistics and univariates analyses were used to compare covariates between groups. RESULTS Of the 2014 patient encounters identified, 482 were included. Twenty-nine (6.0%) of the 482 included encounters had treatment failure. There was no difference in the mean duration of intravenous antibiotics (3.4 ± 2.5 days, 3.5 ± 2.8 days, P = .87) or total antibiotics between children with and without treatment failure (10.2 ± 3.8 days, 10.8 ± 4.0 days, P = .39) Of note, there was a higher rate of bacteremia in children with treatment failure (P = .04). CONCLUSIONS In children with CAKUT/NGB and UTI, 6.0% of encounters had treatment failure. Duration of antibiotics was not associated with treatment failure. Larger studies are needed to assess whether bacteremia modifies the risk of treatment failure.
    Type of Medium: Online Resource
    ISSN: 2154-1663 , 2154-1671
    URL: Article
    DOI: 10.1542/hpeds.2023-007427
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2024
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  • 6
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    Diagnostic Accuracy of the Urinalysis for Urinary Tract Infection in Infants 〈3 Months of Age
    American Academy of Pediatrics (AAP) ; 2015
    In:  Pediatrics Vol. 135, No. 6 ( 2015-06-01), p. 965-971
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 135, No. 6 ( 2015-06-01), p. 965-971
    Abstract: The 2011 American Academy of Pediatrics urinary tract infection (UTI) guideline suggests incorporation of a positive urinalysis (UA) into the definition of UTI. However, concerns linger over UA sensitivity in young infants. Infants with the same pathogenic organism in the blood and urine (bacteremic UTI) have true infections and represent a desirable population for examination of UA sensitivity. METHODS: We collected UA results on a cross-sectional sample of 276 infants & lt;3 months of age with bacteremic UTI from 11 hospital systems. Sensitivity was calculated on infants who had at least a partial UA performed and had ≥50 000 colony-forming units per milliliter from the urine culture. Specificity was determined by using a random sample of infants from the central study site with negative urine cultures. RESULTS: The final sample included 245 infants with bacteremic UTI and 115 infants with negative urine cultures. The sensitivity of leukocyte esterase was 97.6% (95% confidence interval [CI] 94.5%–99.2%) and of pyuria ( & gt;3 white blood cells/high-power field) was 96% (95% CI 92.5%–98.1%). Only 1 infant with bacteremic UTI (Group B Streptococcus) and a complete UA had an entirely negative UA. In infants with negative urine cultures, leukocyte esterase specificity was 93.9% (95% CI 87.9 – 97.5) and of pyuria was 91.3% (84.6%–95.6%). CONCLUSIONS: In young infants with bacteremic UTI, UA sensitivity is higher than previous reports in infants with UTI in general. This finding can be explained by spectrum bias or by inclusion of faulty gold standards (contaminants or asymptomatic bacteriuria) in previous studies.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2015-0012
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2015
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  • 7
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    Authors’ Response
    American Academy of Pediatrics (AAP) ; 2015
    In:  Pediatrics Vol. 136, No. 4 ( 2015-10-01), p. e1167-e1168
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 136, No. 4 ( 2015-10-01), p. e1167-e1168
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2015-2606B
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2015
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  • 8
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    The Effect of Readmission for Phototherapy on Early Breast Milk Feeding
    American Academy of Pediatrics (AAP) ; 2022
    In:  Hospital Pediatrics Vol. 12, No. 5 ( 2022-05-01), p. e146-e153
    Details
    In: Hospital Pediatrics, American Academy of Pediatrics (AAP), Vol. 12, No. 5 ( 2022-05-01), p. e146-e153
    Abstract: To estimate the effect of readmission for inpatient phototherapy on parent-reported exclusive and any breast milk feeding at 2-month well-child visits. METHODS We performed a retrospective cohort study using electronic health record data. From births at 16 Kaiser Permanente Northern California hospitals (2013–2017), we identified a cohort of infants ≥35 weeks’ gestation with outpatient total serum bilirubin levels ranging from 1 mg/dL below to 2.9 mg/dL above the American Academy of Pediatrics phototherapy threshold at & lt;15 days of age. We compared breast milk feeding at 2-month well-child visits among those readmitted and not readmitted to the hospital for phototherapy, adjusting for bilirubin and other confounding variables. RESULTS Approximately one-quarter (26.5%) of the cohort (n = 7729) were readmitted for phototherapy. Almost half (48.5%) of the infants who were not readmitted for phototherapy received exclusively breast milk at the 2-month visit compared with slightly fewer infants who were readmitted (42.9%). In both groups of infants, most (82.2% not readmitted and 81.2% readmitted) received any breast milk. Readmission for phototherapy was associated with a lower adjusted risk of exclusive breast milk feeding (adjusted risk ratio 0.90; 95% confidence interval [CI], 0.84 to 0.96), corresponding to a marginal absolute reduction in exclusive breast milk feeding of 5.0% (95% CI, −7.9% to −2.1%). It was not associated with a reduction in any breast milk feeding (adjusted risk ratio, 1.00; 95% CI, 0.97 to 1.02). CONCLUSIONS Infants readmitted for phototherapy were more likely to receive any formula, but no less likely to receive any breast milk at 2-month well-child visits.
    Type of Medium: Online Resource
    ISSN: 2154-1663 , 2154-1671
    URL: Article
    DOI: 10.1542/hpeds.2021-006295
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2022
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  • 9
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    Initiating Phototherapy at Subthreshold Levels : The Slippery Slope
    American Medical Association (AMA) ; 2018
    In:  JAMA Pediatrics Vol. 172, No. 4 ( 2018-04-01), p. 322-
    Details
    In: JAMA Pediatrics, American Medical Association (AMA), Vol. 172, No. 4 ( 2018-04-01), p. 322-
    Type of Medium: Online Resource
    ISSN: 2168-6203
    URL: Article
    DOI: 10.1001/jamapediatrics.2017.5744
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2018
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  • 10
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    A Simpler Prediction Rule for Rebound Hyperbilirubinemia
    American Academy of Pediatrics (AAP) ; 2019
    In:  Pediatrics Vol. 144, No. 1 ( 2019-07-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 144, No. 1 ( 2019-07-01)
    Abstract: We previously reported a clinical prediction rule to estimate the probability of rebound hyperbilirubinemia using gestational age (GA), age at phototherapy initiation, and total serum bilirubin (TSB) relative to the treatment threshold at phototherapy termination. We investigated (1) how a simpler 2-variable model would perform and (2) the absolute rebound risk if phototherapy were stopped at 2 mg/dL below the threshold for treatment initiation. METHODS: Subjects for this retrospective cohort study were infants born 2012–2014 at ≥35 weeks’ gestation at 1 of 17 Kaiser Permanente hospitals who underwent inpatient phototherapy before age 14 days. TSB reaching the phototherapy threshold within 72 hours of phototherapy termination was considered rebound. We simplified by using the difference between the TSB level at the time of phototherapy termination and the treatment threshold at the time of phototherapy initiation as 1 predictor, and kept GA as the other predictor. RESULTS: Of the 7048 infants treated with phototherapy, 4.6% had rebound hyperbilirubinemia. The area under the receiver operating characteristic curve was 0.876 (95% confidence interval, 0.854 to 0.899) for the 2-variable model versus 0.881 (95% confidence interval, 0.859 to 0.903) for the 3-variable model. The rebound probability after stopping phototherapy at 2 mg/dL below the starting threshold was 2.5% for infants ≥38 weeks’ GA and 10.2% for infants & lt;38 weeks’ GA. CONCLUSIONS: Rebound hyperbilirubinemia can be predicted by a simpler 2-variable model consisting of GA and the starting threshold–ending TSB difference. Infants & lt;38 weeks’ gestation may need longer phototherapy because of their higher rebound risk.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2018-3712
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2019
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