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Efficacy of bladder stimulation techniques for urine collection from infants: a systematic review and meta-analysis

Ochoa-Sangrador C, Fernández-Rodríguez A

Servicio de Pediatría, Hospital Virgen de la Concha, Complejo Asistencial de Zamora, Spain. Escuela de Enfermería de Zamora, Spain.

Background and objective. Collecting a urine sample from an infant is one of the most frequently performed emergency department procedures. We aimed to evaluate noninvasive bladder stimulation techniques to obtain urine samples from infants.
Methods. Systematic review and meta-analysis of published experimental and observational studies indexed in MEDLINE (PubMed Central); the Cumulative Index of Nursing and Allied Health Literature (CINAHL); the Ibero-American index, CUIDEN; and Embase. Eligible studies had to have assessed the success rate of a technique, time until urination, level of acceptance, and risk of contamination. Comparison of a stimulation technique to nonstimulation was not necessary.
Results. We selected 15 studies enrolling newborns or older infants. The setting was usually an emergency department. The probability of success was 2.4-fold higher with stimulation than without it (relative risk, 2.47; 95% CI, 1.84–3.31; I2, 0%) in 2 studies. The rate of success was higher in newborns (81%; 95% CI, 72.9%–89.1%) in 6 studies totaling 331 cases (I2, 73.2%) than in older infants (51.5%; 95% CI, 35.3%–67.7%) in 9 studies with 809 cases (I2, 96.4%). The mean time required to obtain a sample was 83 (95% CI, 65–101) seconds in 10 studies (I2, 94.3%). The stimulation technique of Herreros had the highest success rate (68.4%; 95% CI, 56.2%–80.7%; I2 95,1%).
Conclusions. New stimulation techniques for taking urine samples from infants are useful, especially in newborns. Advantages are the short time to urination, the high success rate, and the possibility of lowering the infant’s levels of stress and pain.

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