The NICE guidelines for UTI recommend US in evaluation of UTI in children <6 months of age within 6 weeks of the UTI if typical infection or during the acute infection if an atypical infection [16]. In the study by Goldman et al [9] on newborn AMAB with UTI, 8 of 12 children with abnormal postnatal US had a normal intrauterine US; 1 patient had posterior urethral valves, and 4 patients had grades III and IV VUR. The main limitations of US are the detection of pyelonephritis, scarring, and VUR. In a study by Chang et al [22] for evaluation of young infants (<3 months of age) with bacteremic UTI, US kidneys and bladder and fluoroscopic VCUG abnormalities were common, and the authors did not refer to any special imaging considerations for bacteremia in imaging decisions for otherwise well- appearing young infants with UTI. US has a high specificity (97.2%) for the detection of findings suggestive of VUR in children after the first UTI [23]. Sensitivity of US for the detection of findings suggestive of high-grade VUR is markedly improved when uroepithelial thickening is considered [24]. The main limitation of US is the low sensitivity (76.5%) for detecting VUR and renal scarring [25-31]. Voiding Urosonography VUS is an alternative to VCUG for the evaluation of VUR in children, with a comparable sensitivity and specificity ranging from 80% to 100% and 77.5% to 98%, respectively [32-39]. The diagnostic accuracy of VUS compared Variant 2: Child assigned female at birth (AFAB). First febrile urinary tract infection with appropriate response to medical management. Initial imaging. CT Abdomen and Pelvis With IV Contrast There is no relevant literature to support the use of CT abdomen and pelvis with IV contrast in the evaluation of a child AFAB <2 months of age for the initial imaging of a first febrile UTI.
Urinary Tract Infection Child. The NICE guidelines for UTI recommend US in evaluation of UTI in children <6 months of age within 6 weeks of the UTI if typical infection or during the acute infection if an atypical infection [16]. In the study by Goldman et al [9] on newborn AMAB with UTI, 8 of 12 children with abnormal postnatal US had a normal intrauterine US; 1 patient had posterior urethral valves, and 4 patients had grades III and IV VUR. The main limitations of US are the detection of pyelonephritis, scarring, and VUR. In a study by Chang et al [22] for evaluation of young infants (<3 months of age) with bacteremic UTI, US kidneys and bladder and fluoroscopic VCUG abnormalities were common, and the authors did not refer to any special imaging considerations for bacteremia in imaging decisions for otherwise well- appearing young infants with UTI. US has a high specificity (97.2%) for the detection of findings suggestive of VUR in children after the first UTI [23]. Sensitivity of US for the detection of findings suggestive of high-grade VUR is markedly improved when uroepithelial thickening is considered [24]. The main limitation of US is the low sensitivity (76.5%) for detecting VUR and renal scarring [25-31]. Voiding Urosonography VUS is an alternative to VCUG for the evaluation of VUR in children, with a comparable sensitivity and specificity ranging from 80% to 100% and 77.5% to 98%, respectively [32-39]. The diagnostic accuracy of VUS compared Variant 2: Child assigned female at birth (AFAB). First febrile urinary tract infection with appropriate response to medical management. Initial imaging. CT Abdomen and Pelvis With IV Contrast There is no relevant literature to support the use of CT abdomen and pelvis with IV contrast in the evaluation of a child AFAB <2 months of age for the initial imaging of a first febrile UTI.