Urinary tract infection (UTI) refers to an infection in the urinary system, including the kidneys, ureters, bladder, and urethra. Typically caused by bacteria, viruses, yeast, and parasites, UTI is more common in women than men due to the location of the urethra, which is closer to the rectum. Women visiting hospitals with the complaint of UTI are at 50 percent and five percent in children. Some factors such as anatomical and immune disorders, frequent use of antibiotics, vaginal products, and prolonged catheterization are involved in this overlap [1,.2] 

Urinary tract infection is a common pediatric diagnosis. The symptoms of urinary tract infection in babies do not differ materially from the symptoms of a variety of childhood ailments, including gastroenteritis, common cold, and vaccination reaction. The signs and symptoms of UTI in babies are generally grouped into systemic symptoms and local symptoms. Systemic symptoms include fever, hypothermia, apnea, and listlessness. Listless babies do not respond actively to their environment - for example, they may not feed actively when hungry or turn to their mother's talk. This sign has not previously been directly investigated for urinary tract infection. The local symptoms of UTI in babies are fever and an unusual smell and/or notice of urine. The other two signs of UTI in babies are issue-specific, and do not directly occur when there is an infection in organs located at another site in the body. The rarity of these signs and other properties also indicate an infection in the urinary tract rather than at another site [3].

The most common cause of urinary tract infection in infants under the age of six months is bacterial infection, reaching from 80% to 90%. If no proper and efficient treatment is carried out, bacterial urinary tract infection has a high probability to evolve into chronic pyelonephritis and renal damage, presenting with limitation in children's growth development and even some long-term impacts from late phase. Bacteria attach and colonize on the uroepithelial cells in urinary system transferred from the gastrointestinal tract and translocated by the bloodstream, the oral-fecal route, some genitourinary abnormalities, and so on. Escherichia coli (E. coli) remains the most frequently isolated organism, reaching approximately 80% among all the pathogens. It is also reported that Enterococcus spp. accounts for about 0% to 10% of the isolated uropathogens from urinary tract infection [4,5].

The diagnosis of UTI in babies can be challenging because the symptoms mimic so many other, more common conditions. When a child is listless and has a fever, a health professional may suspect that a UTI or a kidney problem is the cause. Standard diagnostic methods for UTIs are not perfect and can be painful, so medical guidelines recommend that healthcare providers consider the risks and benefits for each patient before ordering tests [6,7]. 

Most guidelines offer a variety of diagnostic methods that together can be effective within the constraints of each individual health system. At present, in America and the UK, guidelines for the diagnosis of suspected UTI among pre-toilet-trained children are largely in agreement and include identification of the preferred method of urine collection, whether this is nappy pads or clean catch, and culturing a urine sample taken using a method that minimizes contamination [8]. 

However, national guidelines diverge in their recommendations for the diagnosis of confirmed UTI among pre-toilet-trained children screened for the infection. The American Academy of Pediatrics recommends diagnosing all screened children using urinary culture, while the National Institute for Health and Care Excellence (UK) recommends diagnosing all screened children using urinary dipstick. It remains unclear how these differing screening pathways affect the likelihood of a timely and accurate diagnosis of UTI in listless babies. Further evidence of the costs and benefits of these 2 healthcare pathways is needed before experts can recommend the best approach. If definitive evidence is unlikely to be obtained, a consensus on the preferred pathway among healthcare experts may help deliver a consistent service to all communities in the meantime [9].

This was a cross sectional study conducted in Bint Al Huda teaching hospital for maternity and children at Nasiriya city, Iraq in emergency department, NCU and clinical Lab. 100 cases selected randomly of listless neonates below or equal to 28 days old of both genders who were listless presented to our hospital between the 1st of February 2024 to the 1st of August 2024. The parents or the health giver were informed about benefits and risks and verbal agreement were taken. Data was collected using Demographic data and subjected to detailed history taking including prenatal, natal and postnatal history with stress on symptoms suggested infection in the mother during pregnancy. Study protocol approved by the scintific department in the Thi-Qar medical college. Urine was always obtained under sterile conditions using standard methods. We used the smallest-diameter foley catheter to avoid traumatic complication. Sterile container for specimen collection. We did not use a catheter with a balloon and/or a guidewire, but we used NG tube in some cases for urine collection.

Urine culture was immediately performed. The urine samples were cultured in blood agar and MacConkeys media. Inoculation was done with help of caliber loop. All the sample plates were incubated for 24_48hrs.at 37c.Bacterial identification was done by standard biochemical test. When multiple growths were obtained the culture was repeated again before accepting the results. positive cultures were stained by Gram stain and Antimicrobial sensitivity was assessed using conventional plate. Timing of the procedure when the infant had not recently voided (1 to 2 hours) after the last wet nappy to reduce the chance of an unsuccessful attempt according to procedure of Iraqi study [10] 

A total of 100 neonates had been included in the study.  The gender distribution of neonates was 45(64.29%) males and 25(35.71%) females as shown in figure 1. The prevalence of neonates with positive growth on culture was 57.1%(40 neonates)

Table (1): Clinical Presentations of Neonates

Table (2): Type of Bacteria on Culture

Table 2 shows that the most common type of bacteria causing UTI is E. coli followed by Klebsiella. There 20 patients show no growth on culture.

Table (3) Drug sensitivity and resistant.

Inspite that not all tests for sensitivity had been done for all patients, from table 3 we notice that Amikacin had the higher sensitivity.

Table (4) Logistic regression of different predictors for development of UTI (Adjusted odds ratio)

In table (4) there is no significant association between different predictors and development of urinary tract infection except for age so those with late neonatal period (>7days) are at higher risk for development of UTI than those with early neonatal period. Also significant for UTI of mother during pregnancy so neonate of mother with UTI during pregnancy more likely to develop UTI.

Early diagnosis and proper treatment are crucial in the management of neonatal urinary tract infection. Additionally, urinary tract infection could be a predisposing factor for lethargy.

Therefore, the current study tried to assess the prevalence of Urinary tract infection among a group of neonates at Bint Al Huda teaching hospital. The current study found that 40% of mothers of neonates had signs of urinary tract infection during pregnancy this consistent with a previous study in Gana conducted by [10] who found association between the history of UTI in mother and occurrence of UTI in neonate.

The more frequent types of bacteria in the culture revealed that E. coli was the more frequent bacteria followed by Klebsiella, Proteus, S.aureus  where positive culture among the urine samples in the neonates for these bacteria was 45%,25%,15%,10%  respectively. Previous studies and literatures in Spain mentioned that E. coli, Klebsiella are the more frequent cause of urinary tract infection [11] who found that E. coli was the most common cause of urinary tract infection (57.14%), the second most common was Klebsiella (42.86%).

The current study found that age more than 7days was significantly risk factor for urinary tract infection in addition to urinary tract infection during pregnancy among mothers both are significant risk factor (P value less than 0.05) from the other point of view neonates of male gender, rural residance, poor antenatal care and crowded houses were more likely to have urinary tract infection [12,13]. However, the correlation with these possible risk factors did not reach the statistical significance (P value more than 0.05). This insignificance might have attributed to lower sample size. Previous study in This our result similar to study in East Africa & Al Najaf, Iraq. These concludes effect of male gender, rural residence, poor antenatal care and crowded houses on UTI.

Early diagnosis and proper treatment are crucial in the management of neonatal urinary tract infection. Additionally, urinary tract infection could be a predisposing factor for lethargy.

The more frequent types of bacteria in the culture revealed that E. coli was the more frequent bacteria followed by Klebsiella, Proteus, S.aureus  where positive culture among the urine samples in the neonates for these bacteria was 45%,25%,15%,10%  respectively. 

The current study found that age more than 7days and positive UTI during pregnancy were significantly risk factor for urinary tract infection from the other point of view neonates of male gender, rural residence, poor antenatal care and crowded houses were more likely to have urinary tract infection, however, the correlation with these possible risk factors did not reach the statistical significance (P value more than 0.05). 

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Southern Technical University.

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