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5 months. Thirteen children (9.4%) experienced breakthrough fUTI. On univariate analysis, UDR (p = 0.01) and VURx (p = 0.0005) were associated with breakthrough UTI, while grade (p = 0.09) did not reach significance. Area under the curve was generated as a measure of accuracy for each variable and was 0.77 for VURx, 0.71 for UDR and 0.68 for grade, demonstrating superiority of VURx for predicting breakthrough fUTI. CONCLUSIONS Children with higher VURx are at increased risk for breakthrough febrile UTI independent of reflux grade. VURx