CT Abdomen and Pelvis Without IV Contrast There is no relevant literature to support the use of CT abdomen and pelvis without IV contrast in the evaluation of a child AMAB <2 months of age for the initial imaging of a first febrile UTI. CTU Without and With IV Contrast There is no relevant literature to support the use of CTU in the evaluation of a child AMAB <2 months of age for the initial imaging of a first febrile UTI. Urinary Tract Infection-Child DMSA Renal Scan A Tc-99m dimercaptosuccinic acid (DMSA) scan can be done for the initial imaging, close to the time of febrile UTI to evaluate for the presence of pyelonephritis. If the DMSA scan is normal, voiding cystourethrography (VCUG) may be avoided in >50% of individuals [14]. Tc-99m DMSA has a good image quality and is a desirable agent for renal cortical scintigraphy, especially in small infants, in patients with poorly functioning kidneys, and when other studies have identified dilated uropathy or high-grade VUR [15]. The UK National Institute for Health and Care Excellence (NICE) guidelines do not recommend DMSA for infants <6 months of age with first febrile UTI who respond well to treatment within 48 hours [16]. Fluoroscopy Voiding Cystourethrography Literature on VCUG has mixed recommendations. Fluoroscopic VCUG has been shown to detect VUR in newborn children AMAB even if US is normal [8-11]. A finding of VUR, especially high-grade VUR, may lead to a change in management [9]. VUR is more commonly detected in children AMAB compared with children AFAB [17]. In addition, one of the primary concerns in young infants AMAB is diagnosing posterior urethral valves [9]. The NICE guidelines do not recommend VCUG for infants AMAB <6 months of age with first febrile UTI who respond well to treatment within 48 hours. If there is poor urine flow or if there is a family history of VUR, VCUG may be helpful if there is an abnormal kidney US study [16]. Others advocate performing routine VCUG studies in all newborns AMAB [9].
Urinary Tract Infection Child. CT Abdomen and Pelvis Without IV Contrast There is no relevant literature to support the use of CT abdomen and pelvis without IV contrast in the evaluation of a child AMAB <2 months of age for the initial imaging of a first febrile UTI. CTU Without and With IV Contrast There is no relevant literature to support the use of CTU in the evaluation of a child AMAB <2 months of age for the initial imaging of a first febrile UTI. Urinary Tract Infection-Child DMSA Renal Scan A Tc-99m dimercaptosuccinic acid (DMSA) scan can be done for the initial imaging, close to the time of febrile UTI to evaluate for the presence of pyelonephritis. If the DMSA scan is normal, voiding cystourethrography (VCUG) may be avoided in >50% of individuals [14]. Tc-99m DMSA has a good image quality and is a desirable agent for renal cortical scintigraphy, especially in small infants, in patients with poorly functioning kidneys, and when other studies have identified dilated uropathy or high-grade VUR [15]. The UK National Institute for Health and Care Excellence (NICE) guidelines do not recommend DMSA for infants <6 months of age with first febrile UTI who respond well to treatment within 48 hours [16]. Fluoroscopy Voiding Cystourethrography Literature on VCUG has mixed recommendations. Fluoroscopic VCUG has been shown to detect VUR in newborn children AMAB even if US is normal [8-11]. A finding of VUR, especially high-grade VUR, may lead to a change in management [9]. VUR is more commonly detected in children AMAB compared with children AFAB [17]. In addition, one of the primary concerns in young infants AMAB is diagnosing posterior urethral valves [9]. The NICE guidelines do not recommend VCUG for infants AMAB <6 months of age with first febrile UTI who respond well to treatment within 48 hours. If there is poor urine flow or if there is a family history of VUR, VCUG may be helpful if there is an abnormal kidney US study [16]. Others advocate performing routine VCUG studies in all newborns AMAB [9].