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Screening for urinary tract infection in newborn infants
Volume 83 Number 3
runted individual with hypertension, stria, and acne, goes a long way toward producing noncompliance by the parent and the child. The child whose renal lesion is under control, but who is regressed and passive with an altered body image, is a child who has been severely handicapped by his therapy not by his disease. Reducing the amount and duration of steroid therapy, prolonging the periods of remission, or eliminating all clinical evidences of disease would seem to play an important therapeutic role in these particular children. Toxicity needs scrutiny. The risk to a patient of a therapeutic program must be fully evaluated and appreciated before reasonable judgment concerning potential benefit can be applied. Such is still the case with chlorambucil, for which the long-term effect on the prepubertal human being is still unknown.
Warren E. Grupe, M.D. Department o[ Pediatrics Rainbow Babies and Childrens Hospital 2103 Adelbert Rd. Cleveland, Ohio 44106
Screening for urinary tract infection in newborn infants
Letters to the Editor
rated urine) was accompanied by leukocyte counts in suprapubically aspirated urine above 10 per cubic millimeter in 2t out of 24 cases of urinary tract infection. On the other hand, leukocyturia above 10 per cubic millimeter in suprapubically aspirated urine was not f~und in any of the 62 cases, where the suspicion of urinary tract infection could be excluded by a negative bacterial culture in suprapubically aspirated urine. Furthermore, if 250 leukocytes per cubic millimeter was accepted as an arbitrary limit for bag urine specimens a similar separation between infected and noninfected urine was found in 20 out of 24 cases. Thus in our opinion leukocyte counting in fresh uncentrifuged urine should be re-evaluated being~ in most cases, a useful method for immediate and rapid differentiation between infected and noninfected urine, especially when counted in suprapubically aspirated urine. Otherwise, we completely agree with Edelmann and associates that routine screening for urinary tract infection in neonates is only indicated in certain high-risk groups, such as lowbirth-weight infants, and that adequate collection of urine, i.e., by suprapubic aspiration, should be performed in order to confirm or rule out suspected urinary tract infection in infants.
A. S. Aronson, M.D. N. W. Svenningsen, M.D. Department of Pediatrics University Hospital Lund, Sweden
To the Editor: We have read with great interest the article by Edelmann and associates, 1 in the January, 1973, issue of the JOURNAL. The authors question the diagnostic value of leukocyte counting in neonates with suspected urinary tract infection. As we had the sarne impression until we changed our technique of urine preparation, we would like to comment briefly on this. Instead of centrifugation and sediment analysis we count the leukocytes of fresh uncentrifuged urine in a counting chamber. Several investigators have emphasized that so many variable factors are introduced by centrifugation that it is of uncertain value in a quantitative estimation of the urinary leukocyte eontentY-3 In a prospective study of 86 infants, 60 of whom were neonates, with suspected urinary tract infection, we compared bag urine specimens with simultaneously obtained suprapubically aspirated urine.~ We found that true bacteriuria (bacterial growth in suprapubically aspi-
5 09
REFERENCES 1. Edelmann, C. M., Jr., Ogwo, J. E., Fine, B. P., and Martinez, A. B.: The prevalence of baeteriuria in full-term and premature newborn infants, J. PEDIATR. 82: 125, 1973. 2. Gadeholt, H.: Quantitative estimation of urinary sediment with special regard to sources of error, Br. Med. J. 1: 1547, 1964. 3. Houston, I. B.: Measurement of pyuria in urinary tract infections, Arch. Dis. Child. 44: 480, 1969, 4. Aronson, A. S., Gustafson, B., and Svenningsen, N. W.: Combined suprapubic aspiration and clean-voided urine examination in infants and children, Aeta Paediatr. Scand. In press.
Reply To the Editor: Our experience apparently has been different from that reported by Aronsen and Svenningsen.
runted individual with hypertension, stria, and acne, goes a long way toward producing noncompliance by the parent and the child. The child whose renal lesion is under control, but who is regressed and passive with an altered body image, is a child who has been severely handicapped by his therapy not by his disease. Reducing the amount and duration of steroid therapy, prolonging the periods of remission, or eliminating all clinical evidences of disease would seem to play an important therapeutic role in these particular children. Toxicity needs scrutiny. The risk to a patient of a therapeutic program must be fully evaluated and appreciated before reasonable judgment concerning potential benefit can be applied. Such is still the case with chlorambucil, for which the long-term effect on the prepubertal human being is still unknown.
Warren E. Grupe, M.D. Department o[ Pediatrics Rainbow Babies and Childrens Hospital 2103 Adelbert Rd. Cleveland, Ohio 44106
Screening for urinary tract infection in newborn infants
Letters to the Editor
rated urine) was accompanied by leukocyte counts in suprapubically aspirated urine above 10 per cubic millimeter in 2t out of 24 cases of urinary tract infection. On the other hand, leukocyturia above 10 per cubic millimeter in suprapubically aspirated urine was not f~und in any of the 62 cases, where the suspicion of urinary tract infection could be excluded by a negative bacterial culture in suprapubically aspirated urine. Furthermore, if 250 leukocytes per cubic millimeter was accepted as an arbitrary limit for bag urine specimens a similar separation between infected and noninfected urine was found in 20 out of 24 cases. Thus in our opinion leukocyte counting in fresh uncentrifuged urine should be re-evaluated being~ in most cases, a useful method for immediate and rapid differentiation between infected and noninfected urine, especially when counted in suprapubically aspirated urine. Otherwise, we completely agree with Edelmann and associates that routine screening for urinary tract infection in neonates is only indicated in certain high-risk groups, such as lowbirth-weight infants, and that adequate collection of urine, i.e., by suprapubic aspiration, should be performed in order to confirm or rule out suspected urinary tract infection in infants.
A. S. Aronson, M.D. N. W. Svenningsen, M.D. Department of Pediatrics University Hospital Lund, Sweden
To the Editor: We have read with great interest the article by Edelmann and associates, 1 in the January, 1973, issue of the JOURNAL. The authors question the diagnostic value of leukocyte counting in neonates with suspected urinary tract infection. As we had the sarne impression until we changed our technique of urine preparation, we would like to comment briefly on this. Instead of centrifugation and sediment analysis we count the leukocytes of fresh uncentrifuged urine in a counting chamber. Several investigators have emphasized that so many variable factors are introduced by centrifugation that it is of uncertain value in a quantitative estimation of the urinary leukocyte eontentY-3 In a prospective study of 86 infants, 60 of whom were neonates, with suspected urinary tract infection, we compared bag urine specimens with simultaneously obtained suprapubically aspirated urine.~ We found that true bacteriuria (bacterial growth in suprapubically aspi-
5 09
REFERENCES 1. Edelmann, C. M., Jr., Ogwo, J. E., Fine, B. P., and Martinez, A. B.: The prevalence of baeteriuria in full-term and premature newborn infants, J. PEDIATR. 82: 125, 1973. 2. Gadeholt, H.: Quantitative estimation of urinary sediment with special regard to sources of error, Br. Med. J. 1: 1547, 1964. 3. Houston, I. B.: Measurement of pyuria in urinary tract infections, Arch. Dis. Child. 44: 480, 1969, 4. Aronson, A. S., Gustafson, B., and Svenningsen, N. W.: Combined suprapubic aspiration and clean-voided urine examination in infants and children, Aeta Paediatr. Scand. In press.
Reply To the Editor: Our experience apparently has been different from that reported by Aronsen and Svenningsen.