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  1. I. Definition. Hematuria is the presence of gross or microscopic blood in the urine. More than 5–10 red blood cells per high-power field (HPF) are usually considered significant. Some authors recommend two of three urinalyses show microhematuria before evaluation is undertaken. A red-stained diaper usually signifies hematuria but may be due to bile pigments, porphyrins, or urates.

  2. II. Incidence. Hematuria is not a common problem in newborns. Transient hematuria is common in critically ill neonates. Normal newborns do not have hematuria.

  3. III. Pathophysiology. Hematuria may originate from the glomeruli, renal tubules and interstitium, or urothelium. Common causes include:

      1. A. Trauma. Birth or iatrogenic, such as bladder aspiration or catheterization.

      1. B. Vascular. Renal vein or renal artery thrombosis, hyperosmolar infusions into umbilical catheters.

      1. C. Renal. Renal cortical or medullary necrosis, neonatal glomerulonephritis (most commonly caused by syphilis).

      1. D. Infection.

      1. E. Neoplasms. Rhabdomyosarcoma, Wilms tumor, neuroblastoma, or nephroblastoma, urinary tract obstruction (urolithiasis after Lasix administration), autosomal recessive polycystic kidney disease or infection.

      1. F. Hematologic. Coagulopathy, hemorrhagic disease of the newborn.

      1. G. Perinatal asphyxia.

  4. IV. Risk factors include coagulopathy, urinary tract infection, obstruction, maternal diabetes (renal vein thrombosis), indwelling urinary catheters, umbilical artery catheter, and traumatic delivery.

  5. V. Clinical presentation

      1. A. History. A maternal history of diabetes may arouse suspicion of renal vein thrombosis. The birth history and Apgar scores may suggest perinatal asphyxia. Has Vitamin K been given? (hemorrhagic disease of the newborn).The presence of an umbilical artery catheter with hematuria should immediately raise the possibility of aortic or renal artery thrombosis.

      1. B. Physical examination may reveal the presence of an abdominal mass (obstruction, neoplasm, or renal vein thrombosis). Note if an umbilical artery catheter is in place.

  6. VI. Diagnosis

      1. A. Laboratory studies

        • 1. Urinalysis. Microscopic examination and dipstick testing confirm the presence of blood or other causes of "red urine." Red blood cell casts are seen with intrinsic renal disease such as glomerulonephritis. Bacteria or white blood cells suggest urinary tract infection.

        • 2. Urine culture. Collection of urine by bladder aspiration or catheterization is preferred and outlined in Chapters 24 and 25.

        • 3. Serum urea nitrogen and creatinine levels may reveal renal insufficiency.

        • 4. Coagulation studies. Prothrombin time, partial thromboplastin time, and thrombin time may provide clues to disseminated intravascular coagulation (DIC) or hemorrhagic disease of the newborn. Thrombocytopenia suggests renal vein thrombosis.

      1. B. Radiologic studies

        • 1. Ultrasonography shows neoplasms, renal vein thrombosis, or obstruction in the urinary tract.

        • 2. Ancillary testing such as intravenous urography, arteriography, and nuclear scans may be indicated.

  7. VII. Management. Treatment is directed at the underlying cause.

  8. VIII.Prognosis depends on the etiology.

Ballard RA, Wernosky G: Clinical evaluation of renal and urinary tract disease. In Taeusch HW et al (eds): Avery's Diseases of the Newborn. Philadelphia, PA: Elsevier Saunders, 2005.
Meyers KE: Evaluation of hematuria in children. Urol Clin N Am 2004;31:559-573.  [PubMed: 15313065]

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