Maternal Child

Maternal Child Health ‹ Child Health Notes ‹ July 12

IHS Child Health Notes

"It doesn’t matter if the cat is black or white as long as it catches mice."

- Deng Hsaio P’ing 1904-1997

This is a page for sharing "what works" as seen in the published literature as well as what is done at sites that care for American Indian/Alaskan Native children. If you have any suggestions, comments or questions please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics at steve.holve@tchealth.org

July 2012

Articles of Interest

Quote of the month

“It’s a rather pleasant experience to be alone in a bank at night.”
Willie Sutton (noted bank robber

Articles of Interest

Association of malodorous urine with urinary tract infection in children aged 1 to 36 months.
Pediatrics. 2012 May;129(5):885-90. Epub 2012 Apr 2.

Objective: To determine whether parental reporting of malodorous urine is associated with urinary tract infection (UTI) in children.

Methods: We conducted a prospective consecutive cohort study in the emergency department of a pediatric hospital. All children aged between 1 and 36 months for whom a urine culture was prescribed for suspected UTI (i.e., unexplained fever, irritability, or vomiting) were assessed for eligibility. A standardized questionnaire was administered to the parents. The primary outcome measure was a UTI.

Results: Three hundred ninety-six children were initially enrolled, but 65 were excluded a posteriori either because a urine culture, although prescribed, was not done (11), was collected by bag (39), and/or showed gross contamination (25). Therefore, 331 children were included in the final analysis. Their median age was 12 months (range, 1-36). Criteria for UTI were fulfilled in 51 (15%). A malodorous urine was reported by parents in 57% of children with UTI and in 32% of children without UTI. On logistic regression, malodorous urine was associated with UTI (odds ratio 2.83, 95% confidence interval: 1.54-5.20). This association remained statistically significant when adjusted for gender and the presence of vesicoureteral reflux (odds ratio 2.73, 95% confidence interval: 1.46-5.08).

Conclusions: Parental reporting of malodorous urine increases the probability of UTI among young children being evaluated for suspected UTI. However, this association is not strong enough to definitely rule in or out a diagnosis of UTI.

Editorial Comment

The clinical significance of common childhood symptoms is often unclear. Ear tugging has many parents worried about otitis media while physicians are confident that studies show no association between the two. Green nasal discharge concerns parents even when doctors reassure them that the color change is a normal progression in colds after several days and not a harbinger of sinusitis. Malodorous urine has long been in this ambiguous category: Is it associated with urinary tract infection or not?

This study shows that bad smelling urine is more common in children with UTI than those without disease. In fact, foul smelling urine was more commonly associated with UTI than vomiting, diarrhea or dysuria. Unfortunately malodorous urine is not sensitive or specific enough to be used alone to diagnose UTI. For situations in which it is unclear if the risk of UTI is sufficient to order a catheterized urine specimen, asking about urine odor may help with this decision. When in doubt, especially in infants, the best choice is to do the right test and obtain a catheterized urine specimen to rule in, or out, disease.

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SAVE THE DATE!

5th International Meeting
on Indigenous Child Health
Strong Communities,
Healthy Children
April 19-21, 2013 / Portland, Oregon

Join the Canadian Paediatric Society and the American Academy of Pediatrics, in cooperation with the Indian Health Service and the First Nations Inuit Health Branch, Health Canada, for the 5th International Meeting on Indigenous Child Health. Child health providers and researchers dedicated to working with American Indian, Alaska Native, First Nations, Inuit, and Métis children and families are encouraged to attend. Participants will have the opportunity to share model programs and research, and develop practical skills that can be utilized in community settings.

For updated conference information, visit www.cps.ca or www.aap.org/nach. To submit abstracts, visit www.surveymonkey.com/s/DBR9VP8 Deadline for workshop proposal submission: August 24, 2012. Deadline for abstract submission: September 21, 2012.

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	Maternal Child Health ‹ Child Health Notes ‹ July 12 IHS Child Health Notes "It doesn’t matter if the cat is black or white as long as it catches mice." - Deng Hsaio P’ing 1904-1997 This is a page for sharing "what works" as seen in the published literature as well as what is done at sites that care for American Indian/Alaskan Native children. If you have any suggestions, comments or questions please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics at steve.holve@tchealth.org July 2012 Articles of Interest Quote of the month “It’s a rather pleasant experience to be alone in a bank at night.” Willie Sutton (noted bank robber Articles of Interest Association of malodorous urine with urinary tract infection in children aged 1 to 36 months. Pediatrics. 2012 May;129(5):885-90. Epub 2012 Apr 2. Objective: To determine whether parental reporting of malodorous urine is associated with urinary tract infection (UTI) in children. Methods: We conducted a prospective consecutive cohort study in the emergency department of a pediatric hospital. All children aged between 1 and 36 months for whom a urine culture was prescribed for suspected UTI (i.e., unexplained fever, irritability, or vomiting) were assessed for eligibility. A standardized questionnaire was administered to the parents. The primary outcome measure was a UTI. Results: Three hundred ninety-six children were initially enrolled, but 65 were excluded a posteriori either because a urine culture, although prescribed, was not done (11), was collected by bag (39), and/or showed gross contamination (25). Therefore, 331 children were included in the final analysis. Their median age was 12 months (range, 1-36). Criteria for UTI were fulfilled in 51 (15%). A malodorous urine was reported by parents in 57% of children with UTI and in 32% of children without UTI. On logistic regression, malodorous urine was associated with UTI (odds ratio 2.83, 95% confidence interval: 1.54-5.20). This association remained statistically significant when adjusted for gender and the presence of vesicoureteral reflux (odds ratio 2.73, 95% confidence interval: 1.46-5.08). Conclusions: Parental reporting of malodorous urine increases the probability of UTI among young children being evaluated for suspected UTI. However, this association is not strong enough to definitely rule in or out a diagnosis of UTI. Editorial Comment The clinical significance of common childhood symptoms is often unclear. Ear tugging has many parents worried about otitis media while physicians are confident that studies show no association between the two. Green nasal discharge concerns parents even when doctors reassure them that the color change is a normal progression in colds after several days and not a harbinger of sinusitis. Malodorous urine has long been in this ambiguous category: Is it associated with urinary tract infection or not? This study shows that bad smelling urine is more common in children with UTI than those without disease. In fact, foul smelling urine was more commonly associated with UTI than vomiting, diarrhea or dysuria. Unfortunately malodorous urine is not sensitive or specific enough to be used alone to diagnose UTI. For situations in which it is unclear if the risk of UTI is sufficient to order a catheterized urine specimen, asking about urine odor may help with this decision. When in doubt, especially in infants, the best choice is to do the right test and obtain a catheterized urine specimen to rule in, or out, disease. Return to top of page SAVE THE DATE! 5th International Meeting on Indigenous Child Health Strong Communities, Healthy Children April 19-21, 2013 / Portland, Oregon Join the Canadian Paediatric Society and the American Academy of Pediatrics, in cooperation with the Indian Health Service and the First Nations Inuit Health Branch, Health Canada, for the 5th International Meeting on Indigenous Child Health. Child health providers and researchers dedicated to working with American Indian, Alaska Native, First Nations, Inuit, and Métis children and families are encouraged to attend. Participants will have the opportunity to share model programs and research, and develop practical skills that can be utilized in community settings. For updated conference information, visit www.cps.ca or www.aap.org/nach. To submit abstracts, visit www.surveymonkey.com/s/DBR9VP8 Deadline for workshop proposal submission: August 24, 2012. Deadline for abstract submission: September 21, 2012. Return to top of page