This document provides a clinical practice guideline for the approach and treatment of urinary tract infections in children in the Philippine setting. It was developed by a task force consisting of pediatric nephrologists, a pediatric urologist, and a pediatric infectious disease specialist. The guideline is intended to guide pediatricians, general practitioners, and pediatric care providers in the recognition, diagnosis, short-term treatment, evaluation, and prevention of UTIs in children. It is based on a review of available evidence and is tailored to the Philippine context.
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Fitzgerald was special counsel to the Senate Interstate and Foreign Commerce Committee in 1953. He was commissioned by Congressman Charles Tobey of Massachusetts to investigate the obstruction of natural cancer treatments by the American Medical Association.
His report to the committee is known as “The Fitzgerald Report” of 1953.
Alone, this information is a bombshell. But, to my knowledge the information you are about to read hasn’t been put into the same or connect-the-dots context before.
Dear students get fully solved assignments
Send your semester & Specialization name to our mail id
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Fitzgerald was special counsel to the Senate Interstate and Foreign Commerce Committee in 1953. He was commissioned by Congressman Charles Tobey of Massachusetts to investigate the obstruction of natural cancer treatments by the American Medical Association.
His report to the committee is known as “The Fitzgerald Report” of 1953.
Alone, this information is a bombshell. But, to my knowledge the information you are about to read hasn’t been put into the same or connect-the-dots context before.
Evolution & Fisheries: A Relationship?: Dr. Malin Pinskycoseenow
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Essays On Cancer. Cancer essays - Reliable Essay Writers That Deserve Your TrustKimberly Jabbour
Breast Cancer Information Essay Free Essay Example. Top Cancer Essay Thatsnotus. Essay on cancer pathogenesis and the 6 hallmarks of cancer PHU3111 .... cancer essay. Cancer Writing Assignment Cancer Earth amp; Life Sciences. Cancer in College Students, Essay Sample SpeedyPaper.com. Understanding Breast Cancer - Free Essay Example PapersOwl.com. Environmental Factors that Could Cause Cancer Essay Example Topics .... essay examples: Breast Cancer Essay. Introduction Cancer Today: Origins, Prevention, and Treatment The .... Inflammatory Breast Cancer Essay Example Topics and Well Written .... The dust bowl essay - Trustworthy Writing Service From Top Professionals. How the American Cancer Society Might Provide Education and Support .... Essay on Cancer Cancer Essay for Students and Children in English - A .... The Origin and Treatment of Cancer Essay Example Topics and Well .... Breast cancer college essays. Cancer essays - reportz515.web.fc2.com. Cancer. Approach for Cancer Care Essay Example Topics and Well Written Essays .... Imposing Breast Cancer Essay Thatsnotus. Topic C - Cancer Essay - Cancer is among the worlds deadliest .... Chemotherapy essay Chemotherapy Cancer. Thesis for cancer research paper. 012 Free Breast Cancer Essays Essay About Dreams Thatsnotus. Skin cancer research paper conclusion / custom essay paper writing. Scholarship essay: Cancer essay. Essay on cancer disease. Essay on Introduction and Conclusion to .... Write an essay about cancer. Essay: Cancer. 2019-01-21. Pin on cancer prevention. Cancer essays - Reliable Essay Writers That Deserve Your Trust Essays On Cancer Essays On Cancer. Cancer essays - Reliable Essay Writers That Deserve Your Trust
Variations Encountered in Umbilical Cord Insertion in Human Placentae from a ...ijtsrd
Umbilical cord shows variations in its insertion at the placenta. This reflects the underlying modifications of fetal circulation in the intrauterine life. Knowledge regarding the prevalence of variations in the umbilical cord insertion is essential for obstetricians and peadiatricians to predict the developmental abnormalities in fetal circulation. The present study was done to evaluate the various types of umbilical cord insertions encountered in the human placentae delivered in a tertiary care hospital. 80 placentae with umbilical cords were collected for 6 months from the hospital with the concerned permissions. They were washed thoroughly and fixed in 10 formalin for preservation. Each placenta was observed carefully for the umbilical cord insertion. The results were analysed and represented graphically. There were no considerable knots observed in the stumps of the cords. All the cords had normal three vessels on cross section i.e., two umbilical arteries and one umbilical vein. When the patterns of insertions were examined, 71 showed normal central insertion, 29 were abnormal where 19 marginal, 7 furcate and 3 exhibited velamentous insertion. When compared with other studies, they correlated. The present study depicts the various abnormal types of umbilical cord insertions from the human placentae collected from a tertiary care hospital. Dr. Neelima. P | Dr. R. Ravi Sunder "Variations Encountered in Umbilical Cord Insertion in Human Placentae from a Tertiary Care Hospital" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-5 , August 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33245.pdf Paper Url :https://www.ijtsrd.com/biological-science/biological-system/33245/variations-encountered-in-umbilical-cord-insertion-in-human-placentae-from-a-tertiary-care-hospital/dr-neelima-p
Integral university prospectus 2016 17 educationiconnect.com 786200478600007123
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This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
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Essays On Cancer. Cancer essays - Reliable Essay Writers That Deserve Your TrustKimberly Jabbour
Breast Cancer Information Essay Free Essay Example. Top Cancer Essay Thatsnotus. Essay on cancer pathogenesis and the 6 hallmarks of cancer PHU3111 .... cancer essay. Cancer Writing Assignment Cancer Earth amp; Life Sciences. Cancer in College Students, Essay Sample SpeedyPaper.com. Understanding Breast Cancer - Free Essay Example PapersOwl.com. Environmental Factors that Could Cause Cancer Essay Example Topics .... essay examples: Breast Cancer Essay. Introduction Cancer Today: Origins, Prevention, and Treatment The .... Inflammatory Breast Cancer Essay Example Topics and Well Written .... The dust bowl essay - Trustworthy Writing Service From Top Professionals. How the American Cancer Society Might Provide Education and Support .... Essay on Cancer Cancer Essay for Students and Children in English - A .... The Origin and Treatment of Cancer Essay Example Topics and Well .... Breast cancer college essays. Cancer essays - reportz515.web.fc2.com. Cancer. Approach for Cancer Care Essay Example Topics and Well Written Essays .... Imposing Breast Cancer Essay Thatsnotus. Topic C - Cancer Essay - Cancer is among the worlds deadliest .... Chemotherapy essay Chemotherapy Cancer. Thesis for cancer research paper. 012 Free Breast Cancer Essays Essay About Dreams Thatsnotus. Skin cancer research paper conclusion / custom essay paper writing. Scholarship essay: Cancer essay. Essay on cancer disease. Essay on Introduction and Conclusion to .... Write an essay about cancer. Essay: Cancer. 2019-01-21. Pin on cancer prevention. Cancer essays - Reliable Essay Writers That Deserve Your Trust Essays On Cancer Essays On Cancer. Cancer essays - Reliable Essay Writers That Deserve Your Trust
Variations Encountered in Umbilical Cord Insertion in Human Placentae from a ...ijtsrd
Umbilical cord shows variations in its insertion at the placenta. This reflects the underlying modifications of fetal circulation in the intrauterine life. Knowledge regarding the prevalence of variations in the umbilical cord insertion is essential for obstetricians and peadiatricians to predict the developmental abnormalities in fetal circulation. The present study was done to evaluate the various types of umbilical cord insertions encountered in the human placentae delivered in a tertiary care hospital. 80 placentae with umbilical cords were collected for 6 months from the hospital with the concerned permissions. They were washed thoroughly and fixed in 10 formalin for preservation. Each placenta was observed carefully for the umbilical cord insertion. The results were analysed and represented graphically. There were no considerable knots observed in the stumps of the cords. All the cords had normal three vessels on cross section i.e., two umbilical arteries and one umbilical vein. When the patterns of insertions were examined, 71 showed normal central insertion, 29 were abnormal where 19 marginal, 7 furcate and 3 exhibited velamentous insertion. When compared with other studies, they correlated. The present study depicts the various abnormal types of umbilical cord insertions from the human placentae collected from a tertiary care hospital. Dr. Neelima. P | Dr. R. Ravi Sunder "Variations Encountered in Umbilical Cord Insertion in Human Placentae from a Tertiary Care Hospital" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-5 , August 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33245.pdf Paper Url :https://www.ijtsrd.com/biological-science/biological-system/33245/variations-encountered-in-umbilical-cord-insertion-in-human-placentae-from-a-tertiary-care-hospital/dr-neelima-p
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We provide university prospectus student can check all prospectus in any slide Integral university prospectus 2016 17 educationiconnect.com 7862004786 Integral university
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UTI
1. # 32 Misamis St., Bago Bantay, Quezon City 1105
Tel. Nos.926-6758 / 926-6759 Fax. No. (632) 926-238-L
An Official Publication of the
Philippine Pediatric Society, lnc.
Clinical Practice Guideline
In The Approach And
Treatment Of Urinary Tract
Infection In Children
In The Philippine Setting
2. PHILIPPTNE Pf,DIATRIC S@IETY, INC.
BOARD OT TRUSTSES
200:!2004
OTTICEf,S
IA.tuWt
JOEL A ELISES. [1D,
ESTRILT, P 4LLA& III.D,
!.ICTOR 6, DolC.rO& ttl.D.
aLEX^NDEI (} TUAZON, i,t_D.
JOCELYN J. Y^ltEAO-ftlrNCO. t1D.
MAY E. MOI{TEIIANO, nl(D.
CARI,IEI.o A AIFTLE& M.D,
EE DEL MIJIID('. ITID-
DISCLAIMER
Tt tE@.&IbB @6ir.d in 6. doorr[l ol UE hilipiE Pdiltio
Sodar, h-, Co@iE o! Cri@l PtGt! Gui&liG e i r Ld to GUIDE
9rdtb!.n i. O. (hccir! (td 6Et d) of Fdirfic Flit vft lE
.!sl3lc o, idctsl. h m Ey rlDdd tt r..omD.DddioE D. rqrrdld s
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LIEEIAIION Lf ADAnICO, rnD (MH.D)
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ALE AI{ITIO A- illNAIDO, M.U (Iu.)
lt GARID e oRnz lt_D.
GEnrrSIS c. RIvERr, itD.
}tf,MBEruI
CouDril on CoEEuoity Scrvic. iod Child Adyo.acy
Co-Di't lorr: C.tr6is C, Riv.n, MD.
Mrr, No]! r C. Chur, MD-
Alcjrrdm A. M.rrrdo, MD.
Mry B. Monr.thno, MD.
Advi..r!: P.dr D. Srnto3 Orlmpo, MD.
Crrm.lirt B. Cuyug.n, MD.
Utro F/ Lin, MD.
ComEilr.. on Clinic.l Pnc,ticc cuiddin !
Chrir: r-.oril, P, Dros,Il-D.
Co-ChriE: F.lizrrdo N, crtchcco, il-D.
J.citrto Bh! Mrol.rnrS III, I(D.
M.ob..!: Mr- Asuncior A- Silv6(rr, M-D.
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Judili FraiEr L GrEir. MD-
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4. In nrtd lqeg, lne Ph'Ipprne Heak,r Insurane Corporafton requested the
Philipprne Pedrarnc Soc'c(). lnc (PPS. hlc) rhrough i(s Presidenr then D. Zenarda
L Anronro ro mme up $,rrh a Practice Gurde|ne in rhe Approach and Trenrnrcnt of
Urin ry Tract Inleclion in Childrcn in the local ,ettin8. Dr Antonio th€n fo.med a
Tarl( Forc€ i, lh€ PPs with lhe oooperalion ol th€ P€dratnc Nephrology Sociay of
the Philippines composrd ol promined pediarric nepkoloSisrs, a pcdiarric urolo8isr
ar a p€diatric intectioN d;sease speci.,ist. The Sroup hurdled tlre lask olcoming up
with rhe bcst possiblc evidenc€-bas€d clinical practice Suideline (CPG) on UTL
Wirh rhe cr€nrion in :002 oflhe Commftree on Ctinic-al Prrcric. GLrid€lines. as one
of rhe Presidemial Special Projeds (2002 ro 20fi) of Dr Joel S Elises as rhe
hesidetr ot the Plrihppnre Pedralric Socierv. Inc. Dr Elisds i his cutcureN
capacily as the President ollhe P€diatric N€phrolog) Socr€ry ofthe Philippines. lnc
(PNSP) foruarden the 200:l updar€d version of rhe Prscric€ Cuideline
'n rhe
Approach and Treatmert of Urinary lracl tnfection in Children ro be lhe PNSP'S
contribution ro th€ Philippine Pediarric Socie(y, lnc s ComDine€ on Clinrcll Prad'c!
Guidelines
Work oo rhc Pradice Guid€lin€ in tll€ Approach d Tr€alm€d ofunnary
Trad Ir eclion h Childr€n in lh€ Phitippiues S€ttine rfa5 sraned in nid-lCt) upoo
the re4u€n ol The Phrl Herlth lnsnmnc€ Corpor ion mtrrs€d tkough Dr Zenaida L
Adonro, lhe PPS Pr6ident th.n A PPS Ta-sk Forcc on t,Tl was orgnniz€d in
cooperflion wnh rhc P€diarric NcphroloS] Society of rhc Philippines rko',Bh rhr
€ffons of its Pr6ident Dr Myma B Roscl. Thc Tas& Force on IIII ilwolved
repres€rianves ftom the Pedi{tric Neptuolo8y Solicty of the Philippin6 [Dr
Bertri.e B Canonigo, Dr SoDia B Gonzlez, Dr Bettina C Ccrccnja, Dr Dolor€s D
Bonzor Dr Ma Noftu v Zamoril: a Pedidric U.ologis IDr David T Eolongl and a
reprBcnbtive of $c Pcdiat ic Infc{rior! Die..-sc Soci..y of th€ P'hiltpp'ncs [Dr
Jos€fina C Carlosl. The drafls *rrc pass.d around anong comnitrat mcmb.rs and
PNSP m€mbeB for comm€dts ard sugg€stions. By Jsruary ?000, it was pr€s€rted in
a Postgrrdurtc Cours.. [l was $bmitt€d to lhc Philippine P.diarric Soicry April
2ml
FOREWORD
BeiDs one ol rhe nrosr commonl) encouniered abnornul condilions in lhe
p€dBrnc age Broup. rr rs lery surpnsrn8 ro nore rhar lh€ major obslacle rhe 8rorip
mcounrercd $as rhc lack oflell - designed srudics or uials in our counrry l'h,r fi€
Sroup inilrallr aihed for was lo adopl rhe (lPG formulated by lhe Amerrcan
Academy olPe(liarrics aid tr,ade scvssl nrodiliealtons bas€d on rh€ b€st a,va;lable
lileraturc The mar0 ,,ud,0cation lhat the group drd was orr lhr age srDUping Instud
ofrhe 2 nunhs l(, I ve3rs ol rge group, rhe group tlh that lhe CP(i nn! b€ applied
krrhelirll .angeol tcdialric age Sroup funhernxne. Ih€y fe€l lhal *rlhlheus.of
rhis ( l,(;, uod.r dirS osis or olcr trcamrcnt nrny b. aroidcd
The Croup should b€ comnre ded for the e(,aordrmry etlbn rhey exened
rD lhe nrakingol rh,s(PG lt rs also *onhwh'le to nole lhal lhe group mllaled rhe
ben a[d the nron eu, rcnr lircrature !o.ome up Lvrrh a very relevanl and hmely CPG
N. GATCHECO. MD MSc
Prrclict Guid.Iin. in lt. Appmlch tnd Trttlm.nr of lrri .t Trlrr lrf..ti,or
h Ch d-r.! in .hc }}illppin. SGtrirg
Urinary trrct infectior is orlc of ttlc nost commonly ermrmterEd iflfr.tions
itr children. ReqrrEnc€ is hiSh aorc morbidiry is comlnon [.sFcirlly ir the v€ry
youn8] lnd rEnd lcrning may b. i corB.qucDce. Reducrid, in ,€r.i funcrion ard
hyp.rtcrEioo can bc lory rero rEsrlt3. Aca,I'tc dirgtrolir for urirBry tract inf€dbn
is a musl. Urdue diigmsis c{n cerj3c urur€c$lsry work{p, aq€nse ad a deay to
the pareds; udiagnos.d, may r€srll 10 r6ral dsmaSc-
Tltc objccrive srl's lo dorlop r guidclitrc on tli apprGch on UTI on
children in !h! Philippines bar€d on !ailnble accepled evidencc. TtE lrr8d
populalior: childrcn b€low 18 y€rrc old- It is iDt6tded lo b€ us€d by PcJiatricians,
GeneGI pr0clitioners and pediatric cnre aivers
ldend€d htrhh out oroe: ul Re.osniriotr of rh€ child wuh UTl, [2] Mrkins th€
diagrosis of UTI, []l Shon-icfn Eeirment ofUTI,.[4] Evalulrion of rh. child with
UTL [5] Prevemion ofUTI6nd itr coNequencB.
..
MEOLINE drl.ba!. *as :xrrchJ usrtr8 f(xlr $eparate s.ar.h nrA.8lst
Grcsponding wirh rh€ four ph&ses of th€ dia8nosis and rrcatlnefl ofuTl lhe ri(les
and abstmds re$lting from rhe.e searchG w8s dicribul.d amoo8 commilt€.
members who identified lhose aficlcs th3t are defiflttely or pt6nally us€fu|. The
adicles ltrt{e reprodued in tull However, thc Commin.. ba!.d and modcled thi3
Pra.ricc Guidelin on ttE on th€ T.chnicll Repon on "Uriury TrEt Inf.diors io
Febrile Infarts snd YounB Children' of dl€ Arnt{ican Acadcmy oI Pcdiatrics
lPediarrica, Vol l0], No a, April 1999, pp 8al-8521 - lh€ mos compr€heoliv.
doormenl on t Tt in Children exrsting lo dat€
!
(1>Chatr,
U
on Clinical Praclicc CDide!ines
l,rrlcrialB,R€viev of articles w6e erilurted a..ording io gmding [Sorr@
lnftctious Dise{s€ Socidy ofAjn6icl Quilily Standards fo, lnfertiou! Diceaiesl
5. CAIEGORY
cooa cviacncc to s,pport a monrncadation
DEFINMON
Moderale €udeflce to suppoi a re(dfint,datiol fot
B
Poor ct,idlncc to s,pTorl r r€{ornmcDdadon for or
rlFirul use
c
D Modlrdc cvid.oc.lo Eppon a tc.orltrcrdrlti,o
3g3m$ usa
APPNOACE TO I]RINARY TRACT I FECTION M A PEILITPINE
SETTING
E
REPORT BY THg PPl' 7.1.W FORCE ON URINARY TRACT INFECTION
Objcctivc:
To dw€lop a guideline on the approtch on Urinary trrcl infccdon in children in
Philippio.! bas€d or aysilablc acr.plcd evidgr..
Th€ tar8er populrtion: Children below l8 y€3r3 ofage
S.nina Philippin.s
For whom inrerded: P€diaricia4 gencrlt prarthiotrsr alld pediluic c{r€ givcr!
Mahod:
DEFINITTON
I Eviirenix fron s( lc.st one propctly nndomizE4 clntRJled
trial
tr Evidefi€ from d lt€.$ orE ull desiSned mal c/thdn
rlndomiation:
Iiom coho( or cssc coolrolled amllric dudic.:
urcortrolad qp.rimcrtu
III Evidoc.e from ofn ion ofrHpccl.d arthoriti.s, bas.d or
clinical e,ec.i.fte,
D66iptivc a$diq tr rlpdtt ofogart coDlin 6
GRADE
Good evidene to .rrpport a r.co icttddioo a8!in{
t. D€velopmcln ofconc.?tll 6rideoc€ bar€d m6del
2. Dcv€loplIlcln of! D.cisior tr.. bar.d on fic svidcnc. avlil6bl.
3. A comprchcariye revicw ofsvsilablc dsra (lool aad ilnartrdioflrl)
4. Algorithrh basd on colt+ficfit
MODEL
SulptEr-Probrbility of Utt-Dirgmsis of Um-Tre.trEu-Worti4-
-ldlg't.n ff'up
Mar6i.lJReviev of anicle. lhrll be evrlueted rcc..ding lo 8ndin8 (S(rr]ce
Infecrious Dis€rse Society of A.neri(, Qurlity Srandrrds for hf.rtious DirarEes)
To mEd n..d! in the Philippin€ s.tliB, modiFc.tion ir ltE lge offtors h&!
bo.n &rapl€d in ou Suideline. Irst€ad ofcorcerltelng on th. 2 mos to 2 ycrts r8€
8roup, thi3 guidelinc may be spplicd lo dlc tu l rm8c ofPcdiiric.s. go19 I! &ing
so. w. wouid b€ abl€ ro provide lhc clinici&r wirh e bgicrl &td gridic.l ,pprotdr lo
UTI in Children in our sening. RcvBrcns in l.his firs Suid€linc is cxP.ctld end $'ork
will b€ urdE rrlen ai deemtd n€(as$ry.
ofcrch rcaomfl.rddioo foa oa
t
CATEGORY DEFTNTTION
fu evidarca to srpDori a rcoornmandation for uia
B Mod€rdc cvidac. lo suppn r r.molrct|dlrion for use
c Pmr €vidcncc ro salDDon ! rcaommeodation t,{.in3lusc
D Mod.rde rvid.nc€ to suppon a rcoorffircnd.tion agsin{
E fu cvidan(f to suppon n ft.ommcrdrrion rrlinst ui
3
6. DEFINITION
Evdenc€ from
'l
lerlt one proFdy rando,nize4 cornmlled
uid
Eviderre liom rt lesst one w€ll dcsignid in lrial whhout
rudomi"itior. from cohon or crsG-conuoled analyticrl
studi€s uncrnrroll€d €xp€ritueds
m Evidence from opinion oa rGpect€d Nthorili€s, bas€d on
,jlin,cal exp€rienc., descriptive studres, or reF ts ol cxp.ti
rell€d th€ ofcvid.nc€ on which rEcommcndations arc ba!.d
GRADE
TFE CFILD WTTR PROBABLf, IJRINARY TRACT INFECTION
I- ThC SUSPEC|:
I Thc n€omles Fesentiflg wirh th€ clirical signs ard sylnproms a-s pres.nt€d
intable I
2 F€bril€ infonts (r-38 C) b€low 2 )tars ofage (Table I Doi,/fls)
l. Old€r childrcn mrnifstiDg symptoms ref.fable to urimry trflct (Iiblc l)
lllc cv,den(t for rhis r.(oEo.Ddr.iotr A/IL Hob.rnan A (6,7,8): Shary (9),
Dorhs (5)
II ME FOILOVNG LS AN ALGI)RI'TIfi' ON THE DUGNOSL WORX-AP,
TRD'TMENT AND FOLLOW-AP OF CEII.DNEN WIIT UR]NARY TNACT:
NFECNON.
SASPECTED ANNARY TRACT INFECTION
Tablc I
CT,]NICAL
SYMYTOM
ln gcneral
'nanif€statiors
ol urirary tract infecttons 5r€ noD-scicntiffc
However, lhcre are some sigrls lnd symploms thal tre rasocirted uhh UTl.
Irri I sEtr.q rod
<- (+)rq@d.Ewlt
&'crilF,
. Sepric
. Temp€rarure rnsabihy
. Vomiting
. Lethar8y or irrirabiliry
gain/fa ilu re lo lhrive
. Diarrher
. Abdominalpain
o t'rertucncy, drihbling
urSency dysuria
. WeaI Lrrinar y slreim
. Malodorous urine
. Enuresis
.l!q!!!l!s
SIGN/S
l+l
Irj
t+l
+
t+l
tll
)
t+1
[+l
[+]
I+l
[+]
t
5
S.tool At
AdoLrcalat
(}{d.. l 116
lfuhrt'ri
-iirir;at i;Siq;-A;-__-_
9tIdrxl{leedc..1a9lm^)
blwFr%rsr -
c id.dlila.'
4
-rra.!+*odtudtu+xr'
.lfu'&kl6&srEedfu
I
I
{+l
t+l
[+]
t+l
trl
t+1
l+l
t+l
7. III D,jGNOSIS
Initiai urinslysis
r. Cnm slain on an uncentrifuFd urine sp€cimen has tha bq.t s.nsirivity
(0 9l) an/ fals€ po3itiv€ rllc (0.05). f,vidcr.. ir A.[-n
b. Urirc dipstick t€sts h.! a s€nritivity of 0.88 for ihe prcs€n(. of l€ucocylc
estcBse or nitrate A fals€ polhive rslc of only 004 for tlrc pre*ft:r of
cithcr lac.cyle €slcr.s ofnirltc Evid.rGG ii A,
c. Plrria his s lowcr true posiive rale snd highcr frls. posiliv€ ratc: for
prcrenc€ of j'5 WBdhpf in a c€trEiftgcd urin€ th€ TPR was 0.67 and lh
FPR 21, whcrcas for >10 WBC/mml in uncdnrituBrd urine, thc TPR i!
0 77 and FPR 0-l L Gorelicl (10), Doe, (5 rrbl€ 3c.). EvA.rc. ir C/L
CAVEAT
Parall€l combiralions oftest res'llts maxiDizc s€nsitivity. A st dy wilhiD onc hour of
unne collection usi'!ts caretul on-sil. microscopy with r pBitive combmatior for
larkoclres snd bacreria ha3 a s€nsitiviry of99l. or fr€aler. Wh€o any (ampon€t of
rh. urinalylis is positiv€ - such as LE, dtrilc, blood, protejn3, microsropy for
leukocytes. micr ..py ofbsc(efla-. snd rh€ u;n0lysis is (onsidered ar pos'live. th€
s.nsirivirv is 100c" bul th€ spc.ificitv is onlv 60p/-Hobdrun rn, L,olu (ll)
Hott.ron il z), Hobdrn'n ( | l). Evit.,c. it B/Il
UriD. Cultlrr€:
ftIE-COiO STANDARD IS A}TY BACTERIAL CROWTH AFTER A
iijpreruarc iAP rhis is dorc ,n infinrs bctow orr )€ar of asc T'" b]41
"
*i.
"* iii.,."rta"^i"rt. A diaper rhar has been drv fo' rhirtv minur€s sll indiqle
"
Ui"&. *","irlr"s *.rO urine lo avoid ri emptv Lap' wilh a I cr svrirge atd &r
'..1tr, *rr. u i"""at., pundurc ore c€nrimeter abov€ d'c svmpnv!'3 pubn iD d'G
,,aire-1.i, J"'e gi'es rlrat strun a*av fi'om
"uprapubic
laps. corharmzirion would
be thc n€n bcs choic€ Rcf€r to tabl€ 2
Uii_"..rlll ..,"f, in a coop.'.diie md ptoPerly preDd€d patiqn will Sive a high
scositivily and sPccif city.
Table 2
. Urin. CultuE: l.tcrPrti.lion oIUTI
Mdhod ofcollcdix
. Suprryubic Gpirdiqo
Ounidiv. Cuh'Ei Ufl F!s.d
CEMll oI uitrEyldlotcl ir
eD' mEbct (q.qtio n I l,o
2-3 x rd(TLr/Dl ofco.stJcc
ES.rivc st!8/o.dri)
F.b.ib i.frlt 6 t[il&.o ltf,tttly
hlvc 5q000 CFU/ol GrilaE of
a sh8lcorb,ry pdltogE, ht
irluxim E y bc Ft3.!a vith cqd!
nm > Io0(FtltDl (Hoaaoa A
{7).Dosr(7), +
SyEoroorric pt!€ r
'B!.lV
hlrc l0' CFU,hl of n r,Dslc
trrblry ptlhogcn.
AsysdrDaic Pdi.dr r bd
l*o qcorEDr (rt difr(,ttl
D,* sfi tot cRtl otrh..snc
p.rbospr
tras r specincitY of SfZ to
by hp lfonly orltur.. of
, 9i./. @nririvrrv rnd $Pl.
STSTORY:
Chtrl lisl refer to trble I
Iisrory of preuous proven UTI, oollriFiior, voiding disdd.rs si.n 13
incodin€nc., prwious srrgcri€s csp€citrlly pelvic crr8.ri.s, ambul.tory problcm €ac
PE}'SICAL EXAMTNATION:
A drcrou8n pnysical cxaminalion is a must. Thc cxamincI lhqrld loot for conFrital
def€cls thd co€xisls Brck exam alion such as pr€s€nc€ ofdilnpl€s. hair tufls i" th€
lunbosacral ,rc. indiclting probablc ndrogeric bladdcn t w6 qrGrnili6 must
also b€ exrmin€d. ThorouSh ,Erologic cyarniDadoD mul be inclu&d Re.rr,
Exanin&tion is prn of the exrrDination.
URINALYSIS:
Thc urinalysis is rhc foudrtion by which every child wirh lusFcred u.tnary rlrcl
inlirtion would eitlEr hav€ fifih€r wod( up or pr aBid€ for o6!€rvation. A sludy
wnh ! very tugh scishiviy hn low W€qficny wiu Flt childftfl [o urul€ctss.ry
inv8ivc work-up. A nudy with a low scnritivity rrd high sp.cificity will mi!3
children ai rbk of lon8 term conplicdions of urinary fad inlstio
Propcr Coll.cdon of urii.: Thi! ir th. com.r rton of th. .lto.ittlf.
Requirem€nl i
l. for irfarrs bclow one yt,r ofagg s suprqubic le i! rlcoffircrd.d.
2. A c.thd6i"ad urine i! r aood ahcrnalivc to obrrin urinc 4ecimcn.
3. Midstr€sfl urine collection for coop€rstiic psticnB-older girl!.
cirqrmcis.d boys ad old.r boys who3c forcsttu is .asily rltad.d.
+ Cu[ure ofurin€ specimcns obtained by catheteriziiion
89ry. compued with cukur6 of urine sp€cimens obiained
carh€t€riz.d orltures have
>looocFtr/ml sre con3idered,
speciticity
Routine reollluring - of lh€ unne afler 2 days ofadimicrobial thenpy is
ameratlv not necessarv if the intanr or ,oung chitd htos ll'd crpcdcd
iini*ti..p"n* ",ta
ric
'rop{hoBeD
is ddermincd tu b€ scdhiv' ro the
antimisobial b€inE.adrnini3rt'd
1
6
8. WARNINC ON TEE USE OT BAC SPECIMEN FOR CULTURE:
Cuhure ofb.g spccimen is 100/0 rensitive br have a spelifichy of only 14-84%-
Taylor ( la). Pueno M ( l5) With prevalance rde ofonly 5%, tbe l1r€ of ()llture 6'oflr
lhe urin€ sFcimens fiom a bag to rule in UTI ir likely ro result in a largr number of
frlse positiv€ resulrs Sp€cifically, wilh p.e!"lenc€ of 5% Thal is,85./oofpositive
orhures ofbaS specimen would bc frlse Dol*n(5). gvid.ncc is D/tl
by
VCUC
Dom(5) 5t9 toty/o
VTJR
tb$r (5) 3t% tw. Alt
EurbiE. KA
(15)
ChildM 75% 25-stf/r |t/.
(imlbCirg
lvP)
EorT
Hzolni AY
(17)
Ctil&a tof/.
Sucllic JM
(lE)
udq 14 7<t/" 2<f/, tw.
DMSA
( te)
I- ,lr! !!d
1T/.
Nol ulctul togt
(20)
to0/.
virh
UTI
Mu.ci B
(2t)
Childo
Childrcn (sirb)
14.1, 1% DlttSA.s !
Skitc(22) a% tl% l00p/"
(23)
Clxklrcn
43%
UlrrasonoSraphy alone as a *o.kup for p ients wirh Prolen urin rv Lrafl infe.lion is
inadequare lr is sensjti'e(99-95o/, Cl96%'toff/o)but il irs' tP€.ificitl' ,nod€sl (41-
1.;129lc55%). Ricklvood (23) Evid.rc. i! A-4[
l'he Lrse ofvoiding cy$ourelhrography tlr nuclelj cvslogram) evahates rh€ prelenc€
o. abs€nc€ of vesicoureteml retlur.
'esicouretqal reflux is th€ n)osr common abnormaliry found ir_patienls wirh uinaty
rrac{ rnfrcnon The pr€valercc is loelo to 40oi ' Dom (s-rshlc 6 and lable ? r6'iew
ol ltr.rarur.) Evideoc. h A,/[
I'. 7 REA'|]V ENT:
. Som. rrrimic.obirb for or.l lre.tmcol o[I]Tl
Amoxicillin 20 40 mg^S/&v in I doses
TMP h conrbinalion qith SMX Gl2 fiBTMP 30{0 S},0{pcr
kt p€r day in 2 doses
Su lfisoxaz ole 120- I 50 ftg/tEldav in 4 dos€s
Cefixi,r. 8mg,&8/daYh2do!€3
CephAlerin 50100 n'8/t8/drv in 4 dos€s
Cefidotine Io mgkglday ;i 2 dos€s
Ceforozil l0 ms,&Cday in 2 dos.s
t.ora.ubef 150-10 msACdaY in 2 dos6
. Son'r $olibiolics for prr€nlrl treiltmenl ofUTl
( clinalo.c ?5 mg^t cvt'Y 24 hou6
150 ms,4elday divided every 6
150 mg/kdday divided evcry 6
Celizol;n s0 nslkgdzy drvided ever)' 8
Iv. |+'oR.x.uP
T5ble 3
9
(2at
Childro
8
tt%
Gcnramicin 7 5 m8,4(8,/day dividcd ever.v E
9. 5 ou^g/day div'dd evEry S
Ti(,rciltin
3$ nwtkgday d;vi,ded evdj 6
Ampicillin
lo0 mgAg/day divided every 6
PmplJhcric ,ntibiortu - low scnJm t€vets bur wilh his, urinsrv Ievct
- Hrs minimal effeds on feca, flora
Low cosr and well rotaat€d
% ofthc regular dole given sr b€dtime
Sooc m.imicrobirl for pmhyt i, of UTI
TMP in combrnarioo wirt SMX
kg rs singtc bedrime dose
SIO{ F Ig rwic€ p€, ,c.k
Nitrofumtlloi
l-2 mg/k8 as sirgte daity dose
lG20 g/tg drvided every t2
Nalrdixic Acrd
6 HobermanAlrrald ERR.ynolds EAPenchansty LrchffrDn M;Is urine
cukur. necessary ro rule out uinary roct infecton in yolng fe$rile
children? P€d Infecl Dis, 1996 Apn l5(1).lo+9
7 Hob€nnan,A, Wald E& Rcynolds EA Petlclrrrsky L, Chanon;PyGia
and bacle.iuria in urine spetimens ohlained cltheter fo.fr young
children with fever, J Pediadcs lee4 Api 124 (4) 513'9
8 Hobman A. Chao t{P. Kells DM Hictey R, Davis ttw Ellis D
Prevalence or unrary rracl ,,rfectio in febril. nfants J Pediatr l99l
lul.123(tl li-23
I Sluw K. Mcgo*a, K, Go.elick MH, Shawaru .,S. Scr€snin8 for
orinary tracl infection in dl. Emerg.rrcy D.parmcnt. which tcd is
Be$' Pediirrics Vol I 0 I No6. Iun€ I 998
l0 Gorelick MH, Shaw K. Screening for Urinary Eld infettjon in
Children L,leranrulysis. Pedinrrics Vol lM NoJ Norrmbg1999
ll LohI JA, Po(illr ,VG, G€uder TG, Durn ML, Dudlcy SM. Maf,ing a
pr€sumbpriv€ diatsnosrs of rinary tracl inlirion by usinS a urioalysig
perfomed in an or-sit laborarory J Pediatr 1994 124.513-9
12 Housron IB Pus clll and baclerirl cou s in rh. dil8n8is for urinary
lrrd inf€crions in childhood. A'ch Dis Chil 1961 38 6O0iO5
ll Hobermrn A wald ER Pdchrnsky L. Reynold! EA YoirlB S.
Enhanced urinalysis rs s screning for uriaary tracl infectror Pediatrics
1993;91 I l96l199
14 Toylor CM, White RH The fersibililv of s.re€trin8 presclrcol children
for urinari tract irfection usinS dislides r J Pedirr Nephrol l98l Jun;
(2):lll-a
l5 Pue4o M, De Julian C. Soro M, Del Pozo S. Arador R Perioeal bag vs
cllheledzarion ot' suprapubic aspirarion tbr ihe diaSnosis oa LiTl in
infants in eme.geMy room
It' BurbrS€ K-A, Rd'k AB, Colodny A}1 Bauer SB. Lrbowirz R tlflnary
tracr infeclion in aoys I (,ml 1984 Sep il2(l) 511
17 Elzouki AY. Mir NA l.swal OP. symprornatic urinary trad infcron
in pediairic patie,ts-a dcv€lopmental aspecr lot J Peiiotric Nepluok'gy
1985 Oct-l}}L: 6(4).:67-70
l8 Snrellie JM. Ridgen SP, Prescod NP tionary rract infecuon a
comparison of four melhods of i8vesri-qation Arch Dis Child l')e5
Ma! , 12O) i4'1 -50
l9 Hoberman d wald ER UrinnD' t6c1 lnfccrions in lour febnle
Children Pediatn lnfec DisJ I9q7 Jan l5(l) ll-7
20 Hnaoka M, Hashrmoto C, Iiori C. T$chrda S. Ttullhara II.KoDsho
Y, Strdo M t,lrra$nography lor lie delecli(u ol uretenc fttlur rr
rnfanrswrlh urinary tractinfeclrcn Acla Paedlr Ipn Jun, l8(l)21E-51
2l Mucaj 8i Maqu;Ee B Do€s rouriDe ultrasound have a role i, Ihe
investigalion ofchildren with urinary tracl infecliotr'Cl,n Radiol lgq4
N.{ay.49(5) 124-5
2? Slrite JL. Bissei GS. Kirks DR- Schlueler FJ. Celland Ml. BakrkI
KKDS. tlan Bl Nuclelr cynography aid rcnal uftrasono.rrath
2 ms TMP,l0 n'a of SI!O( Fr
Or 5 m8 of rup, 25 mg of
Mahcnamine rundetate
l0 m-!,&g dividd €very 12
75 mylg drvrdcd wcrj 12 hours
I
Biblio8raphy
I
).1-u1.
sn, sulolor) B {rmpromar,c ard rpro,nar,c @nirv r,a(r
rnlnl!n rn rnhn.r
Am.l DrsChrld r9rt, t:S,$-tl
.' Mc Intvre PB. crav Sv, vancc JC Un$specld rnfedions in febrit€
connrlsions Med J Au{ lq9o. I52. lEl
i Prvl.r C Ludcrs D The badenolo,r ut the urine in rrfa rs an,J
. chrldr€n Errh gavroenrenls I'eU,"r..s i6or, sr/-ESr
I snofllrle I h.z I nnarr trld rrt<.1ion rn infanr, and .hrtdftn
.
( an'pbe.lli. 7'eJn,on t.trh. Reuct Vaughn. U,ein
rntanrr !d un$ Chrtdrcn, pq.tErrics Vut I0t oa Apnl
t0
tl
10. findinSs in Birls !!ith urinary traa infedion AJR Am J Roenrg€trolo8y
1989 Jul, l5l(l). ll5-9
2l Rickwood .AM. Carty I{M, McKendrick T: Wrllialns MP. Jackson M;
Pillirg Dw, Spri!,g A Cunent ima8ing of childhood unnat/ tracl
inl-ections ProsJ,€clive $Ney
a
DISCI,ATMER
TIE ltou@drrioE @fllEd in dF (h{utrEr of & Phlrr?r P€dnm
Soccg. Iirc . CotrDitre on Cldial Po.re Gur.hli6 aE n{.rtr lo CUIDE
pr.ExioEE in rh. da4lDn r td tr@gemnl) of p.rlElnc FIEflt rnt ttt
tlsss or rfi.En tn m ra ilb ld rhe eomren&noc h. e!,d4d as
iberur! nrr6. ,e MEd a'n IE.uliarni6 in i6dNii'.1i:B d |Rdanlar
cdrl dilleclB rn rlr sp.cfr apD'lrn In rlr. .ll.
l6IMcnd,1lro6 dE d s'pphmrI. d NOT rrle sDld ctnsl
'dA
Err nBdc on a €*foqcbis's
ThG acliyities of rh. Cor|Eitt . oo Cliricrl Prr.tk. GuiddiD6 ry.rt prnly
iupponed by rn.ducrtiond gr.nl from S ofFsyrlhehta
I
t)