Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency Department

Abstract

Objective: Midstream clean-catch urine is an accepted method to diagnose urinary tract infection but is impracticable in infants before potty training. We tested the bladder stimulation technique to obtain a clean-catch urine sample in infants.

Materials and methods: We included 142 infants under walking age who required a urine sample in a cross-sectional study carried out during a 3-months period, from September to November 2014, in the emergency department of the University Children's Hospital of Nice (France). A technique based on bladder stimulation and lumbar stimulation maneuvers, with at least two attempts, was tested by four trained physicians. The success rate and time to obtain urine sample within 3 minutes were evaluated. Discomfort (EVENDOL score ≥4/15) was measured. We estimated the risk factors in the failure of the technique. Chi-square test or Fisher's exact test were used to compare frequencies. T-test and Wilcoxon test were used to compare quantitative data according to the normality of the distribution. Risk factors for failure of the technique were evaluated using a multivariate logistic regression model.

Results: We obtained midstream clean-catch urine in 55.6% of infants with a median time of 52.0 s (10.0; 110.0). The success rate decreased with age from 88.9% (newborn) to 28.6% (>1 y) (p = 0.0001) and with weight, from 85.7% (<4 kg) to 28.6% (>10 kg) (p = 0.0004). The success rate was 60.8% for infants without discomfort (p<0.0001). Heavy weight and discomfort were associated with failure, with adjusted ORs of 1.47 [1.04-2.31] and 6.65 [2.85-15.54], respectively.

Conclusion: Bladder stimulation seems to be efficient in obtaining midstream urine with a moderate success rate in our study sample. This could be an alternative technique for infants before potty training but further randomized multicenter studies are needed to validate this procedure.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Study flow chart.

Successful group, n = 79.

Fig 2. Success rate by age in months or years (top panel) and weight in kilograms (bottom panel).

Success rates are presented as histograms with 95% confidence intervals (vertical line). A smooth curve (round dots) represents the success rate based on age (top panel) or on weight (bottom panel).

Fig 3. Frequency of discomfort by age in months or years (top panel) and weight in kilograms (bottom panel).

Frequency of discomfort is defined as an EVENDOL score ≥4/15 at least once during the study protocol. Discomfort rates are presented as histograms with 95% confidence intervals (vertical line). The smooth curve (round dots) represents the discomfort rate based on age (top panel) or on weight (bottom panel).