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Fast and safe technique for collection of urine in newborns

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Fast and safe technique for collection of urine in newborns

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Fast and safe technique for collection of urine in newborns

  1. 1. • Introduction • Aims of the study • Patients and Methods • Results & Discussion • Conclusions & Recommendations.
  2. 2. Control of Muscles involved in Micturation • The detrusor muscle is the (smooth) muscle of the bladder wall and, together with the urethral (internal) sphincter muscle , is innervated by the sympathetic nerve fibres from the lumbar sections of spinal cord, and also by the parasympathetic nerve fibres from sacral segments 2 - 4 of the spinal cord. • These muscles are NOT under voluntary control. • However, the external urethral sphincter muscle is under voluntary control, and as such is innervated by the SNS.
  3. 3. Micturation Reflex • Involuntary Action: by the Peripheral Nervous System (PNS). • Voluntary Action: by the Cental Nervous System (CNS). • The micturation reflex is an autonomic spinal cord reflex that initiates urination.
  4. 4. • To achieve conscious bladder control, several conditions must be present: awareness of bladder filling; cortical inhibition (suprapontine modulation) ability to consciously tighten the external sphincter to prevent incontinence; normal bladder growth; and  motivation by the child to stay dry.
  5. 5. Normal Voiding and Toilet Training • The fetus voids by reflex bladder contraction in concert with simultaneous contraction of the bladder and relaxation of the sphincter. • The infant has coordinated reflex voiding as often as 15-20 times/day. • At 2-4 yr, the child is developmentally ready to begin toilet training. • Girls typically acquire bladder control before boys, and bowel control typically is achieved before bladder control.
  6. 6. Urinary tract infections (UTIs) • Urinary tract infections (UTIs) occur in 1-3% of girls and 1% of boys. • The prevalence of UTIs varies with age. During the 1st yr of life, the male : female ratio is 3- 5 : 1. • Beyond 1-2 yr, there is a female preponderance, with a male : female ratio of 1 : 10.
  7. 7. Urine Sample? • Clean urine samples are necessary for accurate diagnosis of urinary tract infections (UTIs). • A wide range of clinical interventions for urine collection is described in the literature, including noninvasive and invasive methods. • The most common noninvasive technique is urine collection using sterile bags, which is associated with patient discomfort and samples contamination.
  8. 8. • Obtaining a cleancatch urine sample is the recommended method for urine collection in children able to cooperate. • However, in children lacking sphincter control, urine catch is more difficult and time consuming and invasive methods (catheterisation and needle aspiration of urine from the bladder) are sometimes needed. • There are some stimulation techniques that facilitate emptying of the bladder in situations of bladder dysfunction. • Use of such methods in newborns could facilitate the collection of a cleancatch urine sample.
  9. 9. The aim of this study was to determine the success rate and safety of a new noninvasive technique to obtain clean catch urine samples in newborns. Aims of the study
  10. 10. • study location • Heevi pediatrics teaching hospital/ Duhok/Kurdistan/Iraq. • Study Design • A prospective feasibility and safety study • Duration of Data collection. • 2 months from 15th February 2016 to 15th April 2016
  11. 11. • Selection of the study participants: • 75 participants from both genders their age less than 30 days. Patients and Methods
  12. 12. • Exclusion Criteria: • Participants with any illness or any other apparently congenital disorders. • poor feeding, • dehydration, • drug administration prior to urine collection. Patients and Methods
  13. 13. Technique • Two people (physicians) were needed to perform the procedure, and a third to measure the time taken. • This technique involves a combination of fluid intake and noninvasive bladder stimulation manoeuvres.
  14. 14. • The first step is either breastfeeding or providing formula intake for newborn. • Twenty five minutes after feeding, the infant's genitals were cleaned. • A sterile collector was placed near the baby in order to avoid losing urine samples.
  15. 15. • The second step is to hold the baby under their armpits with their legs dangling. • One examiner then starts bladder stimulation which consists of a gentle tapping in the suprapubic area at a frequency of 100 taps or blows per minute for 30 s.
  16. 16. • The third step is stimulation of the lumbar paravertebral zone in the lower back with a light circular massage for 30 s.
  17. 17. • Both stimulation manoeuvres are repeated until micturition starts, and a midstream urine sample can be caught in a sterile collector . • Success is defined as the collection of a sample within 5 min of starting the stimulation manoeuvres.
  18. 18. Data Analysis • SPSS (statistical package for the social sciences) for windows version 19. • A P-value of less than 0.05 was considered to be statistically significant. Patients and Methods
  19. 19. The distribution of age & Gender Participants No. (%) Age (Days) Mean(±SD.) Boys 48 (64%) 9.62± 7.01 Girls 27 (36%) 13.29± 11 Total 75 (100%) 10.94±8.77
  20. 20. The mean time for sample collection Participants Time (Seconds) Median Mean(±SD.) Boys 92.62±102.1 20 Girls 53.89±73.11 28 Total 79.4 ± 94.05 24 There was an 82.7% success rate (n=62/75)
  21. 21. • Urine was sometimes obtained before the end of the first cycle of stimulation (<60 s) in 35 participants. • No statistically representative differences with regard to sex were found in success rate, time of sample collection or complications. • No complications other than controlled crying were observed.
  22. 22. • the procedure based on manoeuvres described for patients with bladder dysfunction to stimulate bladder emptying through reflex contraction of the detrusor muscle. • The detrusor muscle is innervated by the parasympathetic pelvic nerves (S2–S4). • The spinal micturition reflex is a simple arch reflex. • Distended bladder walls stimulate efferent fibres going to the medulla, the arch reflex is produced in S2–S4, and afferent fibres stimulate the detrusor muscle which contracts to pass urine.
  23. 23. • This reflex is voluntarily inhibited and controlled in continent individuals by the cortex, but not in newborns. • In neonates, it can be triggered, as we propose. • this technique is effective in obtaining a urine sample in a majority of patients in an easy, safe and fast way. • Bag changes, long waiting times and invasive techniques were avoided.
  25. 25. Conclusions & Recommendations • A new method to obtain midstream urine in newborns is described. • It consists of feeding, bladder stimulation and paravertebral lumbar massage. • The technique has been demonstrated to be safe, quick and effective. • The discomfort and waste of time usually associated with bag collection methods can be avoided, as well as invasive techniques.