Non-invasive bladder stimulation effective to obtain urine samples in infants

1. When using a non-invasive bladder stimulating technique to obtain a clean catch urine (CCU) sample, 49% of infants younger than the age of 90 days were able to provide a sample within 45 seconds.

2. Contamination in the CCU group was 16%, as opposed to 5% in the invasive method group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: When febrile infants present to the emergency department, a urine sample is included in their work-up and typically involves invasive procedures such as suprapubic aspiration and urethral catheterization. This study evaluated a new noninvasive bladder stimulation technique to obtain CCUs in infants less than 90 days of age. Results from this study showed that 49% of infants younger than 90 days old were able to provide a CCU within an average of 45 seconds. The contamination rate amongst these samples was 16%. This study was limited by several things: the definition of contamination was arbitrary, the sample size was small, and external validity would be improved with the involvement of more nurses and more sites. Nonetheless, this procedure may provide an effective method of addressing the ambiguity of obtaining urine samples from febrile infants.

Click to read the study, published today in Pediatrics

Relevant Reading: Urinary Tract Infection in Febrile Infants Younger Than Eight Weeks of Age

In-Depth [prospective cohort]: Using 126 subjects less than 6 months of age from a tertiary care pediatric emergency department in Montreal, Canada, CCU samples were obtained by trained research personnel using the bladder stimulation technique. This new method involves a combination of fluid intake and repeated bladder stimulation maneuvers over an hour until the start of micturition. Infants were fed for 20 minutes, genitals were cleaned, and then they were held under the armpits by a parent with legs dangling in males and hips flexed in females. Examiners alternated by gentle tapping in the suprapubic area at a rate of 100 taps per minute for 30 seconds and lumbar paravertebral massage maneuvers for 30 seconds. Urine is then caught in a sterile collector. A total of 62 successful CCUs were obtained within a median time of 45 seconds (49%, 95% CI: 40%–58%). This procedure was successful in 61% of infants aged 0 to 29 days, 54% of children aged 30-59 days, and 62% of children aged 60-89 days. Comparing these results to the control group (invasive procedures) of children less than 89 days, all these groups had a higher proportion of success (p<0.001). The contamination proportion was 16% in the CCU group (95% CI: 8% to 27%), compared to 6% in the invasive method group (95% CI: 3% to 15%).

Image: PD

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