She watched as he inserted the needle gently, aspirating as he advanced it into the bladder, speaking softly to the baby as he worked. It was obvious from the skill and speed of his fingers that he’d performed the procedure many times before.

When he had the sample he withdrew the needle and his gaze flickered to Libby.

‘Can you apply pressure to that site for about two minutes? Then cover it with a dressing.’ He placed the sample on the trolley and turned to Alison. ‘It’s possible that she will have a bit of blood in her urine for the next couple of days so if you notice that in the nappy don’t be alarmed. You can call Libby if you’re worried.’

Libby lifted the gauze and checked that the bleeding had stopped and then applied a dressing. Then she swiftly dressed the sobbing baby and handed her to her mother for a cuddle.

‘Just hold her for a bit and she should settle,’ she advised. ‘She’s had paracetamol and ibuprofen so hopefully her temperature should come down soon.’

Alison looked at her. ‘And the doctor really thinks that she has an infection in her bladder?’

‘Yes, he does. The reason he wants to treat it quickly is because it can spread to the kidneys and cause damage.’

‘But with treatment she should be OK?’

Libby nodded. ‘Dr Christakos will probably want to do more tests to check, but you brought her in straight away so the chances are we’ve caught it before the infection has had time to spread.’

Satisfied that Alison understood the explanation, Libby followed Andreas to the nurses’ station where he was tapping details into the computer.

‘What happens now?’

‘She’s dehydrated so I’m going to put a line in and get some fluid into her. I’m also going to start her on IV antibiotics. When she’s picked up a bit we can give her the rest of the course orally.’

‘You’re not going to wait for the results?’

He shook his head. ‘It’s important to treat her fast. If necessary we can change the antibiotics when the results come back. If the UTI is confirmed, we’ll need to do more tests.’ He didn’t lift his eyes from the screen. ‘All young children have to be investigated for vesicoureteric reflux.’

‘So will you do an ultrasound?’

‘Amongst other things.’ He looked up and smiled briefly. ‘Reflux and scarring can be missed by ultrasound in this age group so she will have to have cystography.’

‘And you’ll send her for a DMSA scan?’

‘Yes. And, Libby…’ He sat back in his chair. ‘We need to try and get her to take oral fluids.’

‘I know.’ Libby nodded, well aware of that fact. ‘Now we’ve got the urine sample I’ll concentrate on that. I’ve explained the importance of fluids to the mother.’

‘Is she breast-feeding?’

Libby shook her head. ‘Bottle.’

Andreas finished what he was doing and stood up. ‘Let’s get that drip up.’

‘I’ll get a trolley ready.’