A Different Kind of Quick Wee
Last month we covered the Quick Wee method of making infants urinate on demand. In infants < 6 months they were able to obtain a clean catch urine specimen in half the infants in a median time of only 45 seconds. Contamination rate was 16% vs 6% (in the invasive group - not statistically significant). What's their technique to make infants void? Show them a photo of mom and dad dressed up to go out for the night after hiring a babysitter? Actually no... good try though. The maneuver starts with allowing the child to feed then tapping the suprapubic area 100 times a minute for 30 seconds, followed by lumbar paravertebral massage for up to 30 seconds. These were alternated and repeated until micturition or 300 seconds elapsed. This is different than the Quick Wee method with moist gauze stimulation of the suprapubic area.
I am a little concerned about the contamination rates with the clean catch, though this is promising. There are circumstances in which contamination is less important that would make this an expeditious, painless way to get a sample.
Pediatrics. 2016 Sep;138(3). pii: e20160573. doi: 10.1542/peds.2016-0573. Epub 2016 Aug 19.
- 1Departments of Pediatrics, and.
- 2Departments of Pediatrics, and Pharmacology, University of Montreal, Montreal, Canada.
- 3Departments of Pediatrics, and firstname.lastname@example.org.
BACKGROUND AND OBJECTIVES:
A new noninvasive bladder stimulation technique has been described to obtain clean-catch urine (CCU) in infants aged <30 days. Objectives were (1) to determine proportion and predictive factors for successful CCU collections using a stimulation maneuver technique among infants <6 months and (2) to determine the proportion of bacterial contamination with this method.
A prospective cohort study was conducted in a tertiary pediatric emergency department among infants <6 months needing a urine sample. CCU samples were collected using a standardized stimulation technique. Invasive technique was performed after CCU for three specific conditions. Primary outcomes were proportions of successful CCU specimens and bacterial contamination. We determined associations between successful urine samples and 4 predictive factors (age, sex, low oral intake, and recent voiding).
A total of 126 infants were included (64 boys, median age: 55 days). The CCU procedure was effective in 62 infants (49%; median time: 45 seconds). Infants 0 to 29 days; 30 to 59 days, and 60 to 89 days had more successful procedures, compared with infants >89 days (odds ratios [95% confidence interval (CI)]: 4.3 [1.4 to 13.4]; 3.2 [1.2 to 8.4]; and 4.44 [1.5 to 13.3], respectively). The contamination proportion was 16% (95% CI: 8% to 27%) in the CCU group. This proportion was not statistically different compared with the invasive method group (6%, 95% CI: 3% to 15%).
The CCU procedure is a quick and effective noninvasive method in children aged <90 days. Contamination proportions were similar to those reported in the literature for urethral catheterization. Circumstances for which the CCU procedure could be performed are proposed.
Copyright © 2016 by the American Academy of Pediatrics.
PMID: 27542848 [PubMed - in process]