Newborns Peeing Blood: When To Be Concerned?

If you notice blood in your newborn's urine, it is important to know that this condition, called hematuria, is quite common and often harmless. However, it is crucial to seek medical advice as it can also indicate an underlying problem. Hematuria can be classified into two types: microscopic hematuria, where blood is only detectable under a microscope, and gross hematuria, where the urine's colour changes to pink, red, or brown due to the presence of blood. While hematuria can sometimes go away on its own, it is important to consult a doctor to determine the cause and receive appropriate treatment if necessary.

Urinary tract infections

It is not normal for a newborn to pass blood in their urine. If this occurs, it is known as hematuria, and it could be a sign of a urinary tract infection (UTI). UTIs are usually caused by bacteria in the kidneys, ureters (the tubes that carry urine), or bladder.

UTIs are common in infants, and they may be the first sign of an underlying renal abnormality, although normal anatomy is most common. Prompt diagnosis and treatment are important to prevent long-term renal scarring. However, increasing antibiotic resistance may delay the initiation of appropriate therapy.

• Occurrence: UTIs rarely occur in the first three days of a newborn's life. They are more commonly seen in older newborns and infants.
• Risk Factors: Uncircumcised boys have the highest risk of developing a UTI, accounting for approximately 70-90% of cases. Other risk factors include maternal history of UTI during pregnancy, premature rupture of membranes, and intrapartum prophylaxis with antibiotics.
• Symptoms: Newborns with UTIs may exhibit symptoms such as fever, crying during urination, cloudy or foul-smelling urine, and irritability. In some cases, fever or a slight illness may be the only sign of a UTI.
• Diagnosis: Urethral catheterization is the preferred method for collecting a urine sample for bacterial culture and diagnosis. Other methods include suprapubic aspiration and sterile bag collection, but they have higher contamination rates.
• Treatment: Ampicillin and gentamicin are the traditional empiric therapies for neonatal UTIs. However, local antibiotic resistance patterns and maternal use of antibiotics before delivery should be considered when choosing the appropriate treatment.
• Recurrence: The risk of UTI recurrence is highest in the first six months after an initial episode. Prophylactic antibiotics are controversial as they may reduce the risk of recurrence but have unclear effects on renal scarring.
• Prevention: Good hydration, frequent urination, and proper hygiene can help prevent UTIs in newborns.
• Underlying Conditions: Underlying renal abnormalities, such as vesicoureteral reflux (VUR), can increase the risk of neonatal UTIs. In some cases, VUR can lead to serious harm to the kidneys from repeated infections.
• Complications: Newborns with UTIs are at risk for concomitant bacteremia and meningitis, so prompt diagnosis and treatment are crucial.

High levels of calcium and other minerals in the urine

Blood in a newborn's urine is called hematuria. It is not normal for a newborn to pee blood, and it could be caused by high levels of calcium and other minerals in the urine. This condition is called hypercalciuria.

Hypercalciuria is a common disorder, affecting 3% to 6% of children and can occur at any age, even in newborns. It is most often seen in children between 4 and 8 years old. Hypercalciuria can be caused by excessive calcium in the urine, which tends to form salts that crystallize and can cause pain or other urinary symptoms. These crystals can also form kidney stones.

There are several risk factors for hypercalciuria, including a family history of kidney stones, not drinking enough fluids, a diet high in sodium and protein, and taking certain medications. Children with hypercalciuria may experience urinary symptoms such as burning, needing to urinate frequently or urgently, and bedwetting. They may also have side, belly, or lower belly pain, repeated urinary tract infections, and irritability.

Hypercalciuria can be diagnosed by measuring calcium in the urine through a 24-hour urine test or a single urine sample. Blood tests, genetic testing, and imaging studies can also be used to rule out other diseases and look for kidney abnormalities.

Treatment for hypercalciuria includes addressing any secondary diseases causing the condition, making dietary changes to increase fluid intake and lower sodium consumption, and adding medications to decrease calcium in the urine or prevent stone formation if necessary. With treatment, the symptoms of hypercalcemia, such as vomiting, dehydration, and failure to thrive, usually improve in childhood. However, affected children may still have higher-than-normal amounts of calcium in their blood and urine, and some may develop kidney stones or other complications later in life.

Kidney or urinary tract stones

It is not normal for a newborn to pass blood in their urine. If this occurs, it could be a sign of hematuria, which is the presence of blood in the urine. This can be caused by a urinary tract infection, kidney stones, or other factors.

Kidney stones, or renal calculi, are uncommon in children and rare in newborns. They are formed when high amounts of certain substances, such as calcium, accumulate in the kidneys, forming crystals or stones. These stones can cause intense pain in the lower back and/or sides, frequent and painful urination, blood in the urine, and urinary tract infections.

If kidney stones are suspected, an abdominal/kidney MRI or an ultrasound can be used to locate the stone. Once found, the stone should be analysed to determine its type. Most stones pass down the urinary tract on their own and are eventually expelled, but pain relievers and increased fluid intake are often needed to manage the pain. Antibiotics may be given if the stone causes a urinary tract infection. Stones that don't pass on their own may need to be removed surgically.

To prevent the recurrence of kidney stones, dietary changes and drinking plenty of fluids are recommended. It is important to limit salt and protein intake and increase the consumption of liquids, especially water.

Hereditary conditions

The presence of blood in a newborn's urine is called hematuria. While it is common in children and usually not serious, it can sometimes be a symptom of an underlying problem that requires medical attention.

Hematuria can be hereditary and may result from the following conditions:

Polycystic Kidney Disease (PKD)

PKD is a genetic disorder characterised by the formation of multiple cysts in the kidneys. These cysts are filled with fluid and can cause the kidneys to enlarge and lose function over time. PKD can lead to high blood pressure, kidney failure, and other complications.

Sickle Cell Disease

This hereditary blood disorder is characterised by abnormal, sickle-shaped red blood cells. These cells can get stuck in blood vessels, blocking blood flow and causing pain and organ damage. Sickle cell disease can affect the kidneys, leading to hematuria.

Hereditary Kidney Disorders

Some kidney disorders that can cause hematuria are inherited, such as certain types of kidney cancer or polycystic kidney disease. These disorders can be identified through a kidney biopsy, where a small sample of kidney tissue is examined under a microscope.

High Levels of Minerals in the Urine

Excessive amounts of minerals, such as high levels of calcium, in the urine (also known as hypercalciuria) can be caused by a variety of hereditary conditions. These conditions can affect the kidneys' ability to filter blood and remove excess minerals, leading to hematuria.

If you suspect that your newborn has hematuria, it is important to consult a doctor as soon as possible. The doctor will conduct a thorough examination, including urine and blood tests, to determine the underlying cause and provide appropriate treatment.

Immune system abnormalities

It is not normal for a newborn to pass blood in their urine. This condition is called hematuria, and it can be caused by several factors, including immune system abnormalities. While it is not typically a serious issue, it is important to consult a doctor to determine the underlying cause.

The immune system plays a critical role in maintaining the health of the urinary tract. Any dysfunction or dysregulation within the immune system can increase the risk of urinary tract infections (UTIs) or other conditions that may lead to hematuria. For example, an overactive or misguided immune response can result in inflammation and tissue damage within the urinary tract, causing blood to appear in the urine.

Additionally, certain immune disorders can affect the kidneys directly, leading to conditions such as glomerulonephritis or nephrotic syndrome. These disorders can cause abnormal leakage of blood components into the urine, resulting in hematuria. In some cases, immune system abnormalities may also be associated with hereditary conditions, further increasing the risk of urinary tract issues.

It is important to note that immune system abnormalities can vary widely in terms of their specific effects on the urinary tract. The presence of blood in the urine can be an early indicator of these abnormalities and should prompt further medical investigation to identify the underlying cause.

If immune system abnormalities are suspected, doctors may recommend additional tests, such as blood work, to evaluate the function and health of the immune system. This information can help guide appropriate treatment and management strategies to address the underlying immune dysfunction and prevent further complications.

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