Quick-Wee versus bladder stimulation to collect midstream urine from precontinent infants under 1 year of age: a study protocol for a randomised controlled trial (ES.Stimquick.U)

Sarah Marchal, Jade Janicot, Julie Salicis, Diane Demonchy, Anne-Laure Herisse, Marco Olla, Anne Rancurel, Hervé Haas, Etienne Bérard, Jean Bréaud, Julie Bernardor, Chloé Ribet, Emma Freyssinet, Dominique Donzeau, Jonathan Desmontils, Clara Schori-Fortier, Eric Fontas, Antoine Tran, Sarah Marchal, Jade Janicot, Julie Salicis, Diane Demonchy, Anne-Laure Herisse, Marco Olla, Anne Rancurel, Hervé Haas, Etienne Bérard, Jean Bréaud, Julie Bernardor, Chloé Ribet, Emma Freyssinet, Dominique Donzeau, Jonathan Desmontils, Clara Schori-Fortier, Eric Fontas, Antoine Tran

Abstract

Introduction: Urinary tract infections occur in around 1%-4% of boys and 3%-8% of girls under 2 years old. Diagnosis is difficult because of non-specific symptoms and the risk of urine analysis contamination depending on the sampling method used for precontinent infants. The American Academy of Pediatrics recommend transurethral catheterisation and suprapubic aspiration because of a low contamination rate but these techniques are invasive. On the other hand, while the National Institute for Health and Care Excellence advocate clean catch urine for its minimal invasiveness and acceptable contamination rate, it is difficult to accomplish in precontinent infants. Two recent methods have been described: the Quick-Wee method by Kaufman et al (suprapubic stimulation with cold saline-soaked gauze); and bladder stimulation by Herreros et al then by Tran et al (pubic tapping alternating with lumbar massage). This study aims to compare the effectiveness in collecting midstream urine by bladder stimulation vs the Quick-Wee method in infants under 1 year, before walking.

Methods and analysis: This study is a multicentre randomised controlled trial of 230 infants under 1 year and before walking who need urine analysis, conducted in four paediatric emergency departments in France. Patients will be randomised into two groups: bladder stimulation and Quick-Wee method.The primary endpoint will be the success rate of voiding at least 2 mL of urine in less than 5 min.Secondary outcomes are the time to collect at least 2 mL of urine, comfort, quality of urine and the risk factors associated with failure of the two techniques.

Ethics and dissemination: The study protocol was approved by the French national ethic committee (consultative committee of the protection of persons). The results of the study will be published in a peer-reviewed journal.

Trial registration number: Clinical Trials Registry - NCT04587999.

Date and protocol version identifier: October 2020, V.1.

Keywords: bacteriology; paediatric infectious disease & immunisation; paediatric urology; pain management; pyelonephritis; urinary tract infections.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Description of the bladder stimulation method. (A) Gentle tapping in the suprapubic area at a frequency of 100 taps per minute; (B) lumbar paravertebral massage maneuvers; (C) collecting midstream urine in a sterile container.
Figure 2
Figure 2
Description of the Quick-Wee method.
Figure 3
Figure 3
Flow chart.

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