Febrile urinary tract infections in 0- to 3-month-old infants: a prospective follow-up study.

OBJECTIVE: To track the clinical evolution of febrile urinary tract infection (UTI) diagnosed in 0- to 3-month-old infants and characterize uropathogen frequencies, antimicrobial resistance rates, renal abnormalities, and differences in the sexes in this age group. STUDY DESIGN: We observed prospectively 46 infants identified in a cohort of 209 children with first UTI diagnosed between July 2006 and July 2008 at the age of 0 to 3 months. Renal ultrasound scanning and voiding cystourethrography examinations were performed in all infants. RESULTS: Infants < 3 months old represented 21% of all children with first UTI. Of these children, 26% were female and 74% were male. Escherichia coli was isolated in 88% of cases and had a high rate of resistance to ampicillin (71%) and to trimethoprim/sulfamethoxazole (47%); 21% of children had vesicoureteral reflux, which was of low-grade in 67% of cases, with spontaneous resolution before 2 years in all cases. In infants with normal ultrasound scanning results, a low-grade vesicoureteral reflux was subsequently found in 10% of cases. CONCLUSION: Infants aged 0 to 3 months represent 21% of children treated for febrile UTI. Boys represent 74% of these cases. E coli is responsible for 88% of UTIs, with a high rate of resistance to antibiotics. When ultrasound scanning examination results are normal, the risk of missing a significant renal abnormality is expected to be extremely low.

Syncope in pediatric patients presenting to an emergency department.

OBJECTIVE: To assess the epidemiology of syncope coming to medical attention among unselected children referred to an emergency department in Western Europe. STUDY DESIGN: We analyzed the cause of syncope and diagnostic workup of 226 consecutive pediatric patients seen in our emergency department because of a syncopal event. RESULTS: Neurocardiogenic syncope and neurologic disorders were the most common diagnoses (80% and 9%, respectively). Other causes included psychologic, cardiac, respiratory, toxicologic, and metabolic problems. The neurocardiogenic and disease-related syncopes were easily identified or suspected by history and physical examination. Electrocardiography was not performed in 132 cases (58%). Most patients with suspected neurocardiogenic syncope had an electroencephalogram, and 29% were admitted to the hospital. Cardiac disorders represented 5 cases (2%); 2 had been previously misdiagnosed. CONCLUSIONS: Syncope in children can result from a wide variety of causes. Consequently, an evaluation that fails to approach this problem in a goal-directed fashion proves to be very expensive, time-consuming, and frustrating to all concerned. Thorough history and physical examination are usually all that are necessary to guide practitioners in choosing the diagnostic tests that apply to a given patient.