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Urine specimens - collection in newborn

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Collection of urine specimens to exclude urinary tract infection

This guideline is intended for situations where antibiotic therapy needs to be commenced within two days. For other purposes, e.g. monitoring for infection in asymptomatic infants with renal tract anomalies, infection screen in 'well' infants with risk factors, a bag urine may suffice if negative on culture.

  • A suprapubic bladder aspiration should be attempted. This is considered a reliable method of obtaining urine for culture in infants. This should be performed prior to handling the baby for any other invasive procedure. The method is as described in McDonald & Ramasethu (2009). 
  • If this is unsuccessful and other investigations can be delayed, replace the infant's nappy and reattempt suprapubic aspiration after 30-45 minutes provided that the nappy is still dry. 
  • If no urine has been collected after two attempts at suprapubic aspiration of if therapy needs to be commenced urgently, then a collection by urethral catheterisation should be attempted. 
  • Catheterisation should be performed by a member of the medical or nursing staff who is familiar with the technique (see urinary catheterisation protocol). An appropriate sized urinary catheter or if not available size 5 French feeding tube or 3.5 umbilical catheter (in that order of preference) should be used. Try to use the smallest-diameter catheter to avoid traumatic complications. 
  • If the catheter does not pass easily, particularly in a baby boy, do not use force because of the risk of urethral trauma. 
  • Collect specimen for culture. Remove the catheter as soon as possible to avoid infectious complications. 

N.B Feeding Tubes are not to be left insitu.

Urine collection by bladder stimulation technique

The bladder stimulation technique can be used to collect a clean urine sample as it facilitates bladder emptying when there is bladder dysfunction2

The bladder is stimulated by gentle tapping of the suprapubic area for 30 s alternated by massaging of the lower back for 30 s. This is done for 5 min in total or until urine has passed. A successful urine collection was seen within 5 min in 69 out of 80 eligible babies with a mean collection time of 57s2.

This technique should be used to collect a urine sample for investigation purposes only and should be requested by the medical staff.

Urine can be used for analysis of microscopy & culture, biochemical analysis or toxicology.

Eligible babies

The bladder stimulation technique is only considered in a stable baby, with stable at the time of collection being defined as:

  • Baby's weight is at least 1.2 kg 
  • The baby is not requiring respiratory support OR 
  • The baby is on high flow / low flow but has been clinically stable for at least a few days 

Equipment

  • Sterile container for urine collection 
  • Antiseptic liquid and gauzes 
  • Sucrose 

Method

Three people are needed for this technique. At least one of them should be a nurse practioner or a trained staff in performing the technique. Follow the steps below.

  1. The first step is either breast-feeding or providing formula intake appropriate to the age and weight of the newborn. If the baby is nil by mouth, discuss if the baby is well enough for this technique with the medical team and make sure the baby has not recently had a wet nappy. Consider imaging by ultrasound to check if the bladder is full. 
  2. Twenty-five minutes after feeding, the infant's genitals should be cleaned with antiseptic solution (esp. important if collection is for microbiology). 
  3. Consider to give sucrose 0.2 ml if the baby is >1,500 g and > 31 weeks' CGA 
  4. One person holds the baby under the armpits with their legs dangling and lower body undressed. 
  5. A second person then starts the 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.
    Bladder stim 1
  6. The next step is stimulation of the lumbar paravertebral zone in the lower back with a light circular massage for 30 s.
    Bladder stim 2
  7. Repeat step 4 and step 5, for maximum 5 minutes, until the baby passes urine 
    Bladder stim 3
  8. Collect the urine sample in a sterile container


References

  1. Suprapubic Bladder Aspiration and Bladder Catheterization, In: Atlas of Procedures in Neonatalogy (4th Ed). MacDonald, G.M. & Ramasethu, J. (Eds), 2009, (pp 108-116).
  2. M. L. Herreros Fernández, N. González Merino, A. Tagarro García, et al. A new technique for fast and safe collection of urine in newborns. Arch Dis Child. 2013;98(1):27-29.

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Document Control

  • Date last published: 19 September 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Review frequency: 2 years