A mother brought in her 3-week-old son on the day she discovered a reddish urine stain in the baby's diaper. There was no stool in the diaper. The boy had been circumcised on the second day of life, and the mother was concerned that her son might have experienced a complication of the procedure.
The infant was delivered vaginally at term after an uncomplicated pregnancy. His Apgar scores were 8 and 9. He weighed 7 lb 5 oz at birth and was 20 inches long. The baby was discharged along with his mother on the day he was circumcised. He was fed exclusively with breast milk and had been gaining weight satisfactorily.
Physicalexamination revealed a healthy- appearing infant in no distress with a well-healed circumcision. The urethral meatus looked elliptical and of normal caliber and was not inflamed. The kidneys and bladder were normal to palpation. The systolic blood pressure in the right upper arm while the baby was supine and quiet was 80 mm Hg. The peripheral perfusion was normal. There were no signs of dehydration. Results of the physical examination were otherwise normal.
WHAT WOULD YOU DO NOW?
A. Prescribe an antibiotic for presumed
urinary tract infection.
B. Obtain a urine specimen for dipstick and
C. Order ultrasonography of the kidneys and
D. Order a voiding cystourethrogram.
FOR MORE INFORMATION:
Cameron JS, Moro F, Simmonds HA. Gout, uric acid and purine metabolism in paediatric nephrology. Pediatr Nephrol. 1993;7:105-118.
Grivna M, Prusa R, Janda J. Urinary uric acid excretion in healthy male infants. Pediatr Nephrol. 1997;11:623-624.
Stapleton FB, Linshaw MA, Hassanein K, Gruskin AB. Uric acid excretion in normal children. J Pediatr. 1978;92:911-914.