Presentation on theme: "A new technique for fast and safe collection of urine in newborns"— Presentation transcript:
1A new technique for fast and safe collection of urine in newborns Herreros Fernández ML, González Merino N, Tagarro García A, Pérez Seoane B, de la Serna Martínez M, Contreras Abad MT, García-Pose A.Arch Dis Child Jan;98(1):27-9
2Clinical question 7 day old infant presents with temperature > 38. Off feeds but otherwise appears wellMildly coryzal but no other clear focusFull septic screenBlood culturesLumbar punctureUrine – how would you obtain? Before or after antibiotics?
3Background to the study Urine samples from infants and children are frequently requested:Septic screenOther clinical reasons eg. TORCH/metabolic screenCollection in neonates and infants is challengingSeveral methods have been trialledSPA (invasive, uncommonly performed)Catheterisation (invasive)Bag/pad urine (difficult to interpret the results if positive)Mid stream/ clean catch (patience required!)
4Local guidelinesSCH advise that a “mid-stream urine” or “clean-catch” is the preferred optionRecognise may be difficult and pad urines etc are acceptableIf “not possible” or “practical” catheter samples or SPA should be performedShould not delay treatment when waiting for a urine if child appears unwellObtain x 2 urines if possible
5Collection of clean catch urine samples – local guidelines Perineum cleaned with waterSmall cardboard urine collecting pot held near the urethral opening until child passes urineNo indication as to how long to wait (!)Image removed for copyright reasons
6Need for a new method…Image removed for copyright reasons
7The solution…Utilise “stimulation techniques” that facilitate emptying of bladder in cases of bladder dysfunctionPurpose of this study is to assess if can be used in neonates to encourage micturition and obtain a clean catch urinePicture removed for copyright purposes
8Methods Prospective “feasibility and safety study” Assessed 90 infants who needed urine collecting for a variety of clinical reasons – all less than 30 daysPrimary end point was the success rate in obtaining an MSU within 5 minutesSecondary variables were time to obtain the sample and any complicationsNo comparison group
9Procedure Feed the baby 25 minutes after feeding clean the genitals Breastfeed or bottle feed25 minutes after feeding clean the genitalsAdministered sucrose to “lessen crying”Hold the baby under the arms with legs danglingGently tap on bladder for 30 secondsMassage sacrum for 30 secondsCatch the urine
10Video demonstration http://adc.bmj.com/content/98/1/27/suppl/DC1 Video removed for copyright purposes
11Results 90 children included in study Mean age approximately 6 days 10 excluded due to “poor oral intake”Mean age approximately 6 days86% succcess rate (passing urine within 5 minutes)Mean time for collection was 57 secondsNo complications“Controlled crying” in all infantsNow adopted as preferred method of urine collection in authors’ centre
12Critical appraisalDifficult to appraise using CASP criteria or GATE as no direct comparison groupOne previous study used a “vibration device” – times typically took one hour for infants to pass urine (Davies et al., 2008)There is some previous evidence for techniqueAbdominal vibration (similar to percussion) effective in patients with MS (Prasad et al., 2003)Massage of lumbar region can cause detrusor contractionNo evidence of its use in neonates or infants prior to this study
13Limitations Lack of control group No indication of parental preference Eg. Would neonates fed 30 minutes before pass urine anyway when nappy removed?No indication of parental preferenceIs it more acceptable than eg catheterisation?Do not comment on contamination rate/false positives for MSU from this techniqueWhat is success rate if child not been fed recently (could it be used in our clinical scenario)?Is it effective in older children?
14Conclusion Undoubtedly a clinical problem Is it an effective solution? Results need replicating in different centre with control groupWider range of ages should be included (? less than one year)Would be useful to know parental opinions about technique and whether acceptable
16ReferencesDavies P, Creenwood R, Benger J. Randomised trial of a vibrating bladder stimulator—the time to pee study. Arch Dis Child 2008;93:423–4.Prasad RS, Smith SJ, Wright H. Lower abdominal pressure versus external bladder stimulation to aid bladder emptying in multiple sclerosis: a randomized controlled study. Clin Rehabil 2003;17:42–7.