New in EM 006: Can you make a baby wee on demand?

2 May

Originally Published on RCEM Learning Podcast June 2017

As part of the RCEM Learning Podcast I record reviews of recent literature with Dave McCreary. We’ve been doing this for about a year now and you can hear them all on the RCEM Learning Podcast each month. I’d like to have them here and searchable on this site too so I’ll be posting the ones I find most relevant here. You can hear the newest ones by subscribing to the free RCEM Learning Podcast. 

Audio:

Can you make a baby wee on demand? (and why would you want to?)

Authors: Dave McCreary, Andy Neill

Clinical Question:

  • Can you make a baby wee on demand?

Title of Paper:

Journal

  • British Medical Journal 2017

Author

  • Kaufman

Background

  • UTIs are common in kids
  • It can be bloody difficult to get a urine sample from a pre-continent infant
  • Anecdotally clinicians have noted infants tend to wee during the cleaning process for a clean catch (and parents have probably noticed that during nappy changes)
  • They reckon there is a cutaneous voiding reflex – it works in animals

Study type

  • Randomised controlled trial
  • Non-blinded
  • Superiority trial

Patients Studied

  • Infants aged 1-12 months requiring urine sample collection

Intervention

  • Gentle suprapubic cutaneous stimulation with a cold saline soaked gauze for 5 minutes (The Quick-Wee method)

Comparison

  • Standard clean catch with no stimulation for 5 minutes

Outcomes

  • Primary – voiding of urine within 5 minutes
  • Secondary – Successful collection / contamination rate / parent and clinician satisfaction

Results

  • Quick-Wee wins
    • 31% vs 12% (p<0.001) voided within 5 minutes
    • Greater satisfaction scores (2 vs 3 on Likert scale)
    • No difference found in contamination
  • NNT 4.7 to successfully collect one additional pot of wee within 5 minutes

Bottom line

  • Quick-Wee is a really simple method that significantly increases likelihood of voiding and catching it within 5 minutes
  • I imagine the novelty would wear off after my first successful attempt and suddenly 5 minutes would seem like a long time – what are the chances we can get the parents in on the action?

Further Reading

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