One of the serious bacterial infections in pediatrics is urinary tract infection (UTI) (1). It often goes unnoticed in newborns due to difficulties in diagnosis, as its symptoms are embedded in the group of overt neonatal sepsis (NNS). In Africa, little data are available on the subject. In fact, only a few hospital series covering a limited number of cases are available. In Madagascar, Robinson et al. (2) found pediatric prevalence of UTI in less than 2% cases. This is because clinical manifestations of UTI are often nonspecific in newborns, not forgetting the high cost that limits access to the cytobacteriological examination of urine (CBEU), a key examination for positive diagnosis (2), and unavailability of the study of urine sedimentation. Moreover, even though the CBEU is done, there are difficulties in collecting urine samples (3).

It has been established in young children that reducing the morbidity associated with UTI and preventing its complications, including kidney scarring, requires early diagnosis and effective treatment of the infection (3,4). In several African countries in the south of Sahara, few teams of pediatricians routinely screen symptomatic newborns for UTI (5). In addition, even if the diagnosis is made, it is rare that further investigations are performed to make etiologic diagnosis or to look for complications that could be severe. The present study was undertaken in 2019 to enrich literature; to make available the data on UTI in newborns not accessible in our country; and to study epidemiological, clinical, etiological, and progressive aspects of UTI in newborns at the Departmental Teaching Hospital of Borgou-Alibori (DTH-B/A).

This was a cross-sectional study with prospective data collection carried out in the neonatology unit of the Departmental Teaching Hospital of Borgou-Alibori (DTH-B/A) in Parakou, Benin, over a period of 5 months (from April 03, 2019 to September 26, 2019). It pertained to all newborns admitted to the neonatal unit of DTH-B/A in 2019 during the study period and meeting study’s inclusion criteria. According to the National Agency for Health Accreditation and Evaluation (NAHAE)recommendations of 2002 (6), all symptomatic newborns whose parents gave their informed consent were included in this study. Newborns with a defect visible from outside the genitourinary system that could be the cause of UTI symptoms were excluded from the study. The sampling was done on non-probability basis by an exhaustive census and involved all newborns admitted to the neonatal unit of DTH-B/A during the study period and meeting inclusion criteria. In addition, a minimum size of 109 newborns was retained on the basis of hospital frequency of UTI in newborns of 7.7% at the Teaching Hospital of Cocody in 2006 (7).

The dependent variable was UTI in the newborn and retained according to the results of CBEU, that is, presence of at least 10,000 leukocytes/mm³ and 1,000,000 bacteria/mm³ National Agency for Health Accreditation and Evaluation (NAHAE) 2002 (6).

The independent variables were socio-demographic aspects (age, gender, and ethnicity), clinical aspects (reason for consultation, gestational history, and physical signs), and paraclinical aspects (urine sedimentation, C-reactive protein, white blood cell [WBC] count, and CBEU).

Urine was collected in an adhesive bag after local disinfection and breastfeeding if possible; the bag was replaced every 30 min even if the newborn did not pass urine. The samples were taken before any antibiotic treatment and sent within 2 h of collection to laboratory for analysis. The urine collected was inoculated on a culture medium; the three culture mediums used were as follows: CLED (Cystine-Lactose-Electrolyte-Deficient) agar, for counting of germs; CHAPMAN agar; and EMB agar.

Urinary sedimentation: Urine sedimentation was carried out with 10 mL of the second urine passed in the morning. The collected urine sample was centrifuged at 2000 revolutions per minute (rpm) for 10 min. Field-by-field analysis under a microscope was conducted with 50 µL of the pellet spread on a slide covered with a cover slip. The cylinders were sought at 200× magnification and all other elements were shown at 400× magnification (8).

Data were collected through an individual face-to-face interview with a parent of the newborn (father or mother) using a developed and pre-tested standardized survey.

Quality control was done on a daily basis. Interpretative reading of antibiograms was made according to the Standards of the French Society of Microbiology (FEMS), edition 2012 (8). If UTI was confirmed, an abdominopelvic ultrasound was performed to search malformative uropathy as a contributing factor in newborn patients.

Sample analysis was carried out in the hospital, and the data were taken and completed from patients’ files. The processing of files was completed manually. Double data entry and analysis were carried out using the Epi info software, version 3.5.4. Tables and figures were produced using the Microsoft Word and Excel software, version 2013. Proportions were calculated for qualitative variables. Quantitative variables were expressed as mean values and standard deviation for those with normal distribution, while median and inter-quartile range (Q1 and Q3) were calculated for quantitative variables with skewed distribution. The proportions were compared using the Chi-square test or Fisher’s exact test. For different associations, the significance threshold used was 5%. This research work was initiated at the Faculty of Medicine of the Teaching Hospital of Borgou-Alibori (DTH-B/A) Written and oral informed consent of a parent (mother or father) of a newborn was obtained before administration of a questionnaire. The rules of anonymity and confidentiality of the information collected were respected.

This was a descriptive and analytical observational study conducted in 2019 to examine epidemiological, clinical, etiological, and evolutionary aspects of UTI in newborns at the Departmental Teaching Hospital of Borgou-Alibori (DTH-B/A).

One of the serious bacterial infections in pediatrics is UTI. The present study demonstrated that 2% of newborns hospitalized presented with UTI without relation to gender. UTI therefore does not appear to be the primary location for neonatal infection. UTI was more common in the early neonatal period. The clinical manifestations were dominated by respiratory distress and jaundice. The germ most frequently involved was Staphylococcus aureus followed by Escherichia coli and Klebsiella oxytoca. Age and position of the urethral meatus were identified as associated factors. No urinary tract malformation was detected on ultrasound. The overall level of resistance of microbes to antibiotics remains very high, which could raise the issue of nosocomial infections.