Imaging studies for first urinary tract infection in infants less than 6 months old: can they be more selective?


This retrospective study aimed to evaluate the applicability of the selective approach of imaging infants < 6 months old with urinary tract infection (UTI) according to the UTI guidelines of the National Institute for Health and Clinical Excellence (NICE) 2007. Infants < 6 months old with their first UTI from January 2001 to December 2006 having undergone an ultrasound examination of the urinary tract, a micturating cystourethrogram, and a late di-mercaptosuccinic acid (DMSA) scan, were included. Their condition was evaluated against a set of risk features according to the UTI guidelines. Those having any one of these were classified as atypical and those having none as typical. There were 134 infants reviewed, with a typical (98 infants) to atypical (36 infants) ratio of 2.7 to 1. Girls were found to be relatively more represented in the atypical group [male (M):female (F) = 1.3:1] than in the typical group (M:F = 4.4:1) (P < 0.004). There were significantly more infants with abnormal micturating voiding cystourethrograms (MCUGs) (P = 0.007), more refluxing ureters (P < 0.001) and more significant vesico-ureteral reflux (VUR) (≥ grade III) (P = 0.013) in the atypical group than in the typical group; while there was no significant difference in ultrasound (US) and DMSA scan findings between the two groups. In the atypical group there was no difference in imaging studies (and, thus, the results) between the conventional practice and the NICE UTI recommendation. In the typical group, if the recommendations of the guidelines had been followed (i.e. only those with abnormal US would have been further investigated), 25 refluxing ureters and 22 scarred kidneys would have been left undiagnosed. In conclusion, application of the suggested selective imaging approach would leave a significant number of VUR and renal scars undiagnosed, and it may not be an optimal practice for infants less than 6 months old with their first UTI. The best approach remains to be clarified.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    Royal College of Physicians Research Unit Working Group (1991) Guidelines for the management of acute urinary tract infection in childhood. J R Coll Physicians Lond 25:36–42

    Google Scholar 

  2. 2.

    American Academy of Pediatrics (1999) Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 103:843–852

    Article  Google Scholar 

  3. 3.

    National Institute for Health and Clinical Excellence (2007) Urinary tract infection in children. NICE, London.

  4. 4.

    Keren R (2007) Imaging and treatment strategies for children after first urinary tract infection. Curr Opin Pediatr 19:705–710

    Article  Google Scholar 

  5. 5.

    Moorthy I, Easty M, McHugh K, Ridout D, Biassoni L, Gordon I (2005) The presence of vesicoureteric reflux does not identify a population at risk for renal scarring following a first urinary tract infection. Arch Dis Child 90:733–736

    CAS  Article  Google Scholar 

  6. 6.

    Tseng MH, Lin WJ, Tsung W, Wang SR, Chu ML, Wang CC (2007) Does a normal DMSA obviate the performance of voiding cystourethrography in evaluation of young children after their first urinary tract infection? J Pediatr 150:96–99

    Article  Google Scholar 

  7. 7.

    Preda I, Jodal U, Sixt R, Stokland E, Hansson S (2007) Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection. J Pediatr 151:581–584

    Article  Google Scholar 

  8. 8.

    Tse KCN, Ding GX, Chiu MC, Lai WM, Tong PC (2009) The relationship between vesicoureteric reflux and renal scarring in infants with urinary tract infection: association or dissociation. Pediatr Nephrol 24:671 (abstract AD-190)

    Article  Google Scholar 

  9. 9.

    Swerkersson S, Jodal U, Sixt R, Stokland E, Hasson S (2007) Relationship among vesicoureteral reflux, urinary tract infection and renal damage in children. J Urol 178:647–651

    Article  Google Scholar 

  10. 10.

    Garin EH, Olavarria F, Nieta VG, Valenciano B, Campos A, Young L (2006) Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 117:626–632

    Article  Google Scholar 

  11. 11.

    Roussey-Kesler G, Gadjos V, Idres N, Horen B, Ichay L, Leclair MD, Raymond F, Grellier A, Hazart I, deParscau L, Salomon R, Champion G, Leroy V, Guigonis V, Siret D, Palcoux JB, Taque S, Lemoigne A, Nguyen JM, Guyot C (2008) Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteric reflux: results from a prospective randomized study. J Urol 179:674–679

    CAS  Article  Google Scholar 

  12. 12.

    Pennesi M, Travan L, Peratoner L, Bordugo A, Cattaneo A, Ronfani L, Minisini S, Ventura A, North East Italy Prophylaxis in VUR study group (2008) Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics 121:e1489–e1494

    Article  Google Scholar 

  13. 13.

    Montini G, Rigon L, Zucchetta P, Fregonese F, Toffolo A, Gobber D, Cecchin D, Pavanello L, Moninari PP, Maschio F, Zanchetta S, Cassar W, Casadio L, Crivellaro C, Fortunate P, Corsini A, Calderan A, Comacchio S, Tommasi L, Hewitt IK, Dalt LD, Zachello G, Dall’Amico R, the IRIS group (2008) Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics 122:1064–1071

    Article  Google Scholar 

  14. 14.

    Mattoo TK (2009) Are prophylactic antibiotics indicated after a urinary tract infection? Curr Opin Pediatr 21:203–206

    Article  Google Scholar 

  15. 15.

    Hellerstein S (2000) Long-term consequences of urinary tract infections. Curr Opin Pediatr 12:125–128

    CAS  Article  Google Scholar 

  16. 16.

    Patzer L, Seeman T, Luck C, Wuhl E, Janda J, Misselwitz J (2003) Day- and night-time blood pressure elevation in children with higher grades of renal scarring. J Pediatr 142:117–122

    Article  Google Scholar 

  17. 17.

    Ahmed M, Eggleston D, Kapur G, Jain A, Valentini RP, Mattoo TK (2008) Dimercaptosuccinic acid (DMSA) renal scan in the evaluation of hypertension in children. Pediatr Nephrol 23:435–438

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Niko Kei-chiu Tse.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tse, N.Kc., Yuen, S.Lk., Chiu, Mc. et al. Imaging studies for first urinary tract infection in infants less than 6 months old: can they be more selective?. Pediatr Nephrol 24, 1699–1703 (2009).

Download citation


  • Infant
  • Urinary tract infection (UTI)
  • Imaging
  • Selective
  • Guidelines