Urinary tract infection and persistent daytime wetting in children: a population based cohort study

P Sureshkumar ¹ , JC Craig, ² and R Cummings, ²
1. Centre for Kidney Research, New Children’s Hospital;
2. Department of Public Health and Community Medicine, University of Sydney

Introduction Daytime wetting and urinary tract infection (UTI) together affect up to 30% of childhood population. Nearly 20% of early school age children have a daytime wetting problem and nearly 8% of children will develop a UTI by 11 years of age1,2. Previous school based study: We conducted a questionnaire based study that identified UTI in 13% and one or more episodes of daytime wetting in a period of 6 months in 19.2% of children entering primary schools1. Other symptoms suggestive of bladder problems were identified in up to 45% of children. Despite the magnitude of the health problems due to these conditions, the causes of UTI in children are largely unknown, and it is also unknown why some children develop bladder control and others do not. There have been a number of cross-sectional studies which have examined the prevalence of daytime wetting at different ages but no population-based cohort study has been done to determine the natural history of daytime wetting and/or risk factors for persistent daytime wetting or new-onset daytime wetting. Similarly, for UTI, although there have been a large number of case series there has never been a population based cohort study of children to determine the risk factors for UTI. This is the first population based cohort study to determine the natural history of daytime wetting and/or risk factors for persistent daytime wetting or new-onset daytime wetting and the frequency and risk factors for symptomatic urinary tract infection. This new survey will be a follow on study from our previous research.

Method:A population based sample of children aged 6-9 years using cluster random sampling of primary schools will be selected. A pilot tested questionnaire will be handed out in classrooms to all children in selected schools. 3800 school children will be approached to participate of which 2700 will be recruited. The questionnaire will be completed by parents and baseline data on demographics, contact details, pregnancy and birth history, presence and frequency of daytime wetting, parental concern, family history of daytime wetting, previous history of UTI, family history of UTI, bowel habits, interventions used to prevent UTI or daytime wetting, medications used, presence and frequency of nightwetting, emotional stressors and symptoms of bladder dysfunction and urge incontinence will be collected. Children who consent to participate will be enrolled into the study and followed for 12 months with a postal questionnaire at 6 and 12 months to measure outcomes relating to the natural history of daytime wetting and to measure any event of UTIs. Reported UTI will be verified from GP or outpatient clinics.

Discussion:This population based cohort study will provide information on the natural history of daytime wetting and bladder dysfunction and their relation to initial or recurrent bacteriologically verified UTI. If modifiable risk factors are found then the next step will be to conduct randomised controlled trials of intervention strategies for both conditions. This is particularly important as to date no intervention has been clearly demonstrated in randomised controlled trials to be effective for children with daytime wetting or for preventing UTI in children. Even if the risk factors identified are unmodifiable (such as family history) and nothing can be done to prevent or treat the problem, extrapolating from other health problems, many children and families are satisfied if they know why the problem has occurred and what will happen over time. Currently this information is not available for daytime wetting and UTI.

Acknowledgement: Funding from NHMRC Public Health Postgraduate Research Scholarship & The Ramaciotti Foundation.
1. Sureshkumar P, Craig JC, Roy LP, Knight JF. Daytime urinary incontinence in primary school children. J Pediatr 137(6), 814-818 (2000).
2. Winberg J, Anderson HJ, Bergstrom T, Jacobsen B, Larson H, Lincoln K. Epidemiology of symptomatic urinary tract infection in childhood. Acta Paediatr Scand 252(suppl), 1-20(1974).
Daytime wetting and urinary tract infection affects 20% and 13% of primary school children who are starting school respectively. The findings of this first population based prospective cohort study will provide unique information about the natural history of daytime wetting in children, the frequency of UTI in children and the risk factors for both conditions which are needed by clinicians, parents and children.

Presented at From Cell to Society 3, Research Conference 2002, College of Health Sciences, University of Sydney, 18 - 19 Sept 2002 Leura, NSW, Australia

Correspondence
Premala Sureshkumar
Centre for Kidney Research
The Children’s Hospital at Westmead
Locked Bag 4001
Westmead NSW 2145 Sydney Australia
Tel: +61 2 9845 3041
Fax: +6 12 9845 3038
Email:Premala Sureshkumar