Fast and safe technique for collection of urine in newborns

2. • Introduction
• Aims of the study
• Patients and Methods
• Results & Discussion
• Conclusions & Recommendations.

3. 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.

4. 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.

5. • 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.

6. 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.

7. 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.

8. 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.

9. • 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.

10. 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

11. • 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

12. • Selection of the study participants:
• 75 participants from both genders their age
less than 30 days.
Patients and Methods

13. • Exclusion Criteria:
• Participants with any illness or any other
apparently congenital disorders.
• poor feeding,
• dehydration,
• drug administration prior to urine collection.
Patients and Methods

14. 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.

15. • 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.

16. • 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.

17. • The third step is stimulation of the
lumbar paravertebral zone in the lower back
with a light circular massage for 30 s.

18. • 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.

20. 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

22. 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

23. 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)

24. • 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.

26. • 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.

27. • 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.

28. CONCLUSION AND
RECOMMENDATIONS

29. 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.

30. THANKS FOR YOUR
ATTENTION