Factors Affecting Prevalence of Urinary Tract Infection in Neonates with Unexplained Hyperbilirubinemia: A Systematic Review and Meta-Analysis Study in Iran

Background: The prevalence and risk factors of urinary tract infection (UTI) in neonates with unexplained hyperbilirubinemia are not studied thoroughly. Since the prevalence of UTI is highly variable in different areas and countries, this study aimed to review the existing data of Iranian neonates with UTI presented with unexplained hyperbilirubinemia. Methods: This study is a meta-analysis of Iranian newborns with unexplained hyperbilirubinemia. We identified all studies indexed in international (Web of Science, PubMed, Scopus, Google Scholar) and national (Science Information Database, Magiran) databases from 2000-2018. Search terms included: Urinary Tract Infections OR UTI AND urine OR culture OR microbio, jaundice OR icter OR hyperbili, AND Iran. Results: Overall, 4210 neonates from 17 studies were included. The pooled prevalence of UTI in neonates with unexplained hyperbilirubinemia was 6.81% (95% CI: 4.86-8.77). Considering the subgroups analyses; the prevalence of UTI was higher in the prolonged vs. not-prolonged state (8.34% vs. 4.00%), low birth weight vs. normal birth weight (7.81% vs. 4.51%), and exclusive vs. non-exclusive breastfeeding (8.84% vs. 4.72%). Male gender and low birth weight increased the risk of UTI about two times compared to the female gender and normal birth weight, respectively. The results of the analyses in neonates with unconjugated hyperbilirubinemia also showed the above-mentioned subgroup differences. Conclusion: Due to considerable prevalence of UTI in neonates with unexplained hyperbilirubinemia and risk factors in this age group, investigation for UTI is essential for the workup in this situation.