UTI in a 5 week old, U/S, VCUG--wwyd?

[tolovemercy]

So, I've spent the last couple of days looking through old threads on this topic, and I guess just want to hear some of you tell me what you would do if you were in my shoes.

DS3, now 6 weeks, was admitted to the hospital last weekend with a UTI. Two weeks prior to that, he was admitted to receive IV antibiotics to treat "cellulitis of the toe"--in other words, he was born with ingrown toenails and one of them became infected and wasn't responding to oral antibiotics (+topical breastmilk, epsom salt soaks, tto). They seem to be growing out just fine after a few weeks of epsom salt soaks, btw.

Anyway, my ped (very alternative friendly) wants to follow up on the UTI with a renal ultrasound (I didn't have one when I was pregnant), and a VCUG.

I don't mind doing an ultrasound--to make sure he does, in fact, have both kidneys and that they're the right size. The VCUG, on the other hand, I'm not sure about--it sounds painful and invasive, among other things. My son is intact and I am totally new at dealing with hospital staff and don't know how to go about making sure that whoever performs the procedure is experienced with catheterizing intact *babies*.

I have so many thoughts floating around in my mind about all of this, and would really love to hear what others have done/would do in this situation.

[mamadelbosque]

My ds2 (now 14.5 months), had a UTI at 2wks... it cleared up just fine and after much soul searching we went ahead with the VCUG/renal ultrasound. Both were clear, thank the gods. But I just felt like I needed to know one way or the other, yk? I'll admit though, that *I* did not go back with him... DH did. I just couldn't do it... but I waited out in the waiting room and nursed him immediatly after.

Good luck!!

[allnaturalmom]

My dd2 (now 3 yo) was hospitalized at 7.5 weeks w/uti. It took some major antibiotics (iv and oral), but did clear up during the expected duration of treatment. She was cath'd for the follow up test (about 2 weeks later) and it came back negative. We did the ultrasound - which showed no abnormalities - and skipped the vcug. We did a lot of soul searching and research w/our decision. Our doctor (mainstream at the time), while he recommended the vcug test, said that he would support our decision either way. She was an otherwise healthy, exclusively breast fed baby. The bacteria was e-coli and we suspected that maybe it was somehow from poop in her diaper. If you have searched this topic, you have probably read my threads.

Good luck w/your decision, mama... I know it is not easy!

[workjw]

It's a very personal decision, but since you asked for opinions I'll share my 2 cents. We were in a similar boat when dd was 6 weeks old. We had the ultrasound done first and it showed no abnormalities of any kind, but we decided to go ahead with the VCUG because we felt like we would be more comfortable knowing if our child had reflux. Like yours, our doctor had said we could skip the VCUG for the first UTI, but that he didn't recommend it. He said that if we didn't know for sure that she did not have reflux we would need to treat her as if she had it.

This meant that we would need to bring her in with every fever to have her urine tested immediately and he recommended giving a rocephin shot and starting a 10 day abx course right away if the urinalysis was positive for UTI. He said he felt comfortable waiting for a culture in kids with no reflux before doing abx, but if there was a chance of reflux then we would need to be very aggressive especially in an infant under the age of one. Infants are much more likely to have kidney scarring from infection than older children. That would be a lot of extra worry and procedures if the child ended up not having reflux after all.

In our case, it turned out that dd does have reflux - grade 5 bilateral. In addition she has 2 extra ureters (both with low grade reflux), an enlarged bladder, and some abnormalities in her kidneys, none of which showed up on her initial renal ultrasound. In the end dd is pretty unique and has much more complicated issues than most. I'm just thankful that we learned about it all so early and we were able to be aggressive with her treatment and save most of her kidney function.

With that said, I certainly don't fault you for not wanting to do the test. It's not a horrible test at that age, but it's still no fun, and knowing doesn't change much if your child doesn't get sick or have recurring infections. If you decide not to do it, just be very aware of signs of UTI. Watch for changes in eating patterns, foul smelling diapers, excessive fussiness for long periods of time and fever. If your kid is "off" and you don't know why, go ahead and test. Tis better to be wrong and feel silly than miss a UTI and have permanent kidney damage.

If you do the test, just be loud and upfront about the fact that your son is intact and ask the nurses and technicians if they have experience with cath'ing an intact boy. If not, insist that they get someone in there that does. You should be able to go back with him during the test so don't be afraid to get close and make sure you can see exactly what they are doing. You might even want to call Child Life Services if it's available at your hospital and talk to them about your concerns. I've found that they are really good at coordinating things for us when they can, and helping with planning and communication.

Good luck with your decision. It's a hard one. Keep us posted about what you decide and how things are going and CONGRATS on your new bundle of joy! Hope the sailing is much smoother from here on out!

[KatWrangler]

Agreed. My daughter was 5 months old when she had her first VCUG and 4 1/2 months old with her first Renal Ultrasound. As it turns out she does have a Neurogenic Bladder and Neurogenic Bowel.

OP, come over to Special Needs Parenting if you have any questions.

Originally Posted by workjw

It's a very personal decision, but since you asked for opinions I'll share my 2 cents. We were in a similar boat when dd was 6 weeks old. We had the ultrasound done first and it showed no abnormalities of any kind, but we decided to go ahead with the VCUG because we felt like we would be more comfortable knowing if our child had reflux. Like yours, our doctor had said we could skip the VCUG for the first UTI, but that he didn't recommend it. He said that if we didn't know for sure that she did not have reflux we would need to treat her as if she had it.

This meant that we would need to bring her in with every fever to have her urine tested immediately and he recommended giving a rocephin shot and starting a 10 day abx course right away if the urinalysis was positive for UTI. He said he felt comfortable waiting for a culture in kids with no reflux before doing abx, but if there was a chance of reflux then we would need to be very aggressive especially in an infant under the age of one. Infants are much more likely to have kidney scarring from infection than older children. That would be a lot of extra worry and procedures if the child ended up not having reflux after all.

In our case, it turned out that dd does have reflux - grade 5 bilateral. In addition she has 2 extra ureters (both with low grade reflux), an enlarged bladder, and some abnormalities in her kidneys, none of which showed up on her initial renal ultrasound. In the end dd is pretty unique and has much more complicated issues than most. I'm just thankful that we learned about it all so early and we were able to be aggressive with her treatment and save most of her kidney function.

With that said, I certainly don't fault you for not wanting to do the test. It's not a horrible test at that age, but it's still no fun, and knowing doesn't change much if your child doesn't get sick or have recurring infections. If you decide not to do it, just be very aware of signs of UTI. Watch for changes in eating patterns, foul smelling diapers, excessive fussiness for long periods of time and fever. If your kid is "off" and you don't know why, go ahead and test. Tis better to be wrong and feel silly than miss a UTI and have permanent kidney damage.

If you do the test, just be loud and upfront about the fact that your son is intact and ask the nurses and technicians if they have experience with cath'ing an intact boy. If not, insist that they get someone in there that does. You should be able to go back with him during the test so don't be afraid to get close and make sure you can see exactly what they are doing. You might even want to call Child Life Services if it's available at your hospital and talk to them about your concerns. I've found that they are really good at coordinating things for us when they can, and helping with planning and communication.

Good luck with your decision. It's a hard one. Keep us posted about what you decide and how things are going and CONGRATS on your new bundle of joy! Hope the sailing is much smoother from here on out!

[tolovemercy]

Thank you ladies, SO MUCH, for being so thoughtful in your replies.

I am still totally on the fence. A friend asked me the other day (discouraging me from doing the VCUG), "Do you *really* think he has a problem?" And the truth is, I can't say that my gut is telling me that this test is not important.

So, I'm still thinking--came back to thank you all profusely (seriously, your input was SO valuable). We are going to do the ultrasound, and I'll keep you all posted with our decisions and results.

[LaurieG]

Just wanted to add our experience. My dd had multicystic dysplastic kidney in one kidney and a dual ureter in the other, diagnosed just before birth d/t low fluid. The original US didn't show any of this. We had a follow up renal ultrasound to confirm or clarify the diagnosis when she was very young - sometime in her 1st month, and then a VCUG shortly after which was negative. We felt it was important for us to go ahead with the VCUG since DD has only 1 kidney that functions and we want to preserve that as much as possible, but I really agonized over the decision. In hind sight I would definitely do it again b/c DD ended up with her good kidney being cystic which we didn't know at the time but all the more reason to do everything possible to prevent UTIs.

But that is our situation which may be quite different from yours. I think proceeding with the renal ultrasound and making the decision based on those results is smart. The answer may become clear as you get more info.

Good luck!

[nicky85]

My son is intact and has spina bifida. I didn't have an ultrasound with him when I was pregnant. The doctors figured his bladder wouldn't work at all and when it did they got really "careful" as in "you need to cath him once a day to be on the safe side", "he needs to have antibiotics every day to be on the safe side", and "we need to do a VCUG with x-ray to make sure his bladder actually does work because 6-8 sopping wet diapers a day and lack of a bacterial infection isn't enough proof that he has normal bladder function". We really felt like we had to go through with it because they wouldn't take him off antibiotics until he had a VCUG and we didn't want to get reported for not giving our child proper healthcare. My son was cathed several times in the hospital and the nurses did just fine with his foreskin.

The VCUG was not my favorite experience, but DS dealt with it fine. He was three months old and he peed all over the nurses when they put the cath in and he tried to kick off all the wires and stuff. He didn't cry or anything and we got to be there with him. It only took a couple of minutes. I don't like u/s, but he had one of those at almost two weeks old on his head to make sure he absolutely did need a shunt placed. They did a renal u/s on him when a few days old. I consider it a necessary evil. It was necessary, so we went through with it. I think if we give him a diet that's healthy and regular chiropractic care, his body will be able to recover from the u/s and x-rays. We keep things to a minimum. If your son is having bladder infections, it really might be worth it to do the u/s find out what's wrong, and then go from there to decide on the VCUG.

BTW- the chiropractic care has done wonders for son and other babies with spina bifida who have urinary issues. You might look into taking him to a traditional pediatric chiropractor and seeing if that might help him his urinary function. Go to www.icpa4kids.org to find one in your area. That's a really good place to look. Good luck!!!!!