Comparison of Pain During Two Methods of Urine Collection in Preterm Infants

El-Naggar, Walid; Yiu, Ashley; Mohamed, Adel; Shah, Vibhuti; Manley, Jennifer; McNamara, Patrick J.; Taddio, Anna

doi:10.1542/peds.2009-3284

Cited by 37 publications

(27 citation statements)

References 20 publications

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“…In the previous technical report, SPA was reported to have success rates ranging from 23% to 90%, 22-24 although higher success rates have been achieved when SPA is conducted under ultrasonographic guidance. 25,26 SPA is considered more invasive than catheterization and, in RCTs from 2006 27 and 2010, 28 pain scores associated with SPA were significantly higher than those associated with catheterization. This result was found for both boys and girls.…”

Section: Obtaining a Urine Samplementioning

confidence: 97%

“…Similar to previous studies, these RCTs also revealed lower success rates for SPA (66% and 60%), compared with catheterization (83% and 78%). 27,28 In comparison with SPA results, cultures of urine specimens obtained through catheterization are 95% sensitive and 99% specific. 7,11,12 Cultures of bag specimens are difficult to interpret.…”

Section: Obtaining a Urine Samplementioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Finnell¹,

Carroll²,

Downs³

2011

Pediatrics

176

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OBJECTIVES: The diagnosis and management of urinary tract infections (UTIs) in young children are clinically challenging. This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial UTIs in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection. METHODS: The conceptual model presented in the 1999 technical report was updated after a comprehensive review of published literature. Studies with potentially new information or with evidence that reinforced the 1999 technical report were retained. Meta-analyses on the effectiveness of antimicrobial prophylaxis to prevent recurrent UTI were performed. RESULTS: Review of recent literature revealed new evidence in the following areas. Certain clinical findings and new urinalysis methods can help clinicians identify febrile children at very low risk of UTI. Oral antimicrobial therapy is as effective as parenteral therapy in treating UTI. Data from published, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI when vesicoureteral reflux is found through voiding cystourethrography. Ultrasonography of the urinary tract after the first UTI has poor sensitivity. Early antimicrobial treatment may decrease the risk of renal damage from UTI. CONCLUSIONS: Recent literature agrees with most of the evidence presented in the 1999 technical report, but meta-analyses of data from recent, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI. This finding argues against voiding cystourethrography after the first UTI.

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Section: Obtaining a Urine Samplementioning

confidence: 97%

Section: Obtaining a Urine Samplementioning

confidence: 99%

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Finnell¹,

Carroll²,

Downs³

2011

Pediatrics

176

View full text Add to dashboard Cite

show abstract

“…Moreover, both methods are associated with pain and discomfort for both the child and caregivers [40].…”

Section: Collection Of Urine Samples For Microbiological Diagnosismentioning

confidence: 99%

Acute pyelonephritis in children

et al. 2015

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Acute pyelonephritis is one of the most serious bacterial illnesses during childhood. Escherichia coli is responsible in most cases, however other organisms including Klebsiella, Enterococcus, Enterobacter, Proteus, and Pseudomonas species are being more frequently isolated. In infants, who are at major risk of complications such as sepsis and meningitis, symptoms are ambiguous and fever is not always useful in identifying those at high risk. A diagnosis of acute pyelonephritis is initially made on the basis of urinalysis; dipstick tests for nitrites and/or leukocyte esterase are the most accurate indicators of infection. Collecting a viable urine sample for urine culture using clean voided methods is feasible, even in young children. No gold standard antibiotic treatment exists. In children appearing well, oral therapy and outpatient care is possible. New guidelines suggest less aggressive imaging strategies after a first infection, reducing radiation exposure and costs. The efficacy of antibiotic prophylaxis in preventing recurrence is still a matter of debate and the risk of antibiotic resistance is a warning against its widespread use. Well-performed randomized controlled trials are required in order to better define both the imaging strategies and medical options aimed at preserving long-term renal function.

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“…We considered a between-group difference of 20% in facial grimacing scores to be a minimal clinically important difference. 37 Assuming an SD of 35%, 65 participants per group were required to detect a 20% between-group difference at the 5% 2-sided level of significance with 90% power. 38 Data were analyzed by using the SPSS statistical software package (version 21; IBM SPSS Statistics, IBM Corporation, Chicago, IL).…”

Section: Discussionmentioning

confidence: 99%

“…27,[32][33][34][35][36][37] These 3 actions have been found to be most frequently associated with tissue damage and exhibit high interobserver reliability, 26 internal consistency, contribute most heavily to the pain experience, 32,33 and are associated with improved specificity without compromising sensitivity or validity. 35 Using a previously described approach, 37 the presence or absence of a facial action was scored for 2-second intervals for each video segment by 2 independent outcome assessors blinded to study hypothesis and group assignment. The percentage of time the facial action was present was calculated for each 30-second segment by dividing the sum of the number of times the facial action was observed in each 2-second interval by the total number of intervals observed, and multiplying by 100.…”

Section: Outcome Measuresmentioning

confidence: 99%

Intraurethral Lidocaine for Urethral Catheterization in Children: A Randomized Controlled Trial

Poonai

Langford

et al. 2015

Pediatrics

Self Cite

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To determine whether lidocaine is superior to nonanesthetic lubricant (NAL) for relieving pain in children undergoing urethral catheterization (UC).METHODS: Children 0 to 24 months requiring UC were randomized to NAL or topical and intraurethral 2% lidocaine gel. Primary outcome was facial grimacing in the pre to during drug administration and catheterization phases. Secondary outcome was caregiver satisfaction by using a Visual Analog Scale.RESULTS: There were 133 participants (n = 68 lidocaine, n = 65 NAL). There were no significant differences in mean ( There were no significant differences in mean (SD) parental satisfaction scores between lidocaine and NAL (4.8 [3.2] vs 5.9 [2.9]), respectively (CI-0.1 to 2.2; P = .06). In the subgroup analysis, age, gender, and positive urine culture did not significantly influence between-group differences in facial grimacing.CONCLUSIONS: Compared with NAL, topical and intraurethral lidocaine is not associated with significant pain reduction during UC, but significantly greater pain during instillation. Therefore, clinicians may consider using noninvasive pain-reducing strategies for young children who require UC. WHAT'S KNOWN ON THIS SUBJECT:Urethral catheterization is a painful, yet common procedure to obtain a sterile urine sample in young children. There are conflicting results regarding the effectiveness of lidocaine to reduce pain, and it is unclear if it should be routinely used. WHAT THIS STUDY ADDS:In young children, combined topical and intraurethral lidocaine does not reduce pain during urethral catheterization and is associated with more pain than nonanesthetic lubricant during instillation. Clinicians should use noninvasive methods of analgesia during this painful procedure.

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Comparison of Pain During Two Methods of Urine Collection in Preterm Infants

Abstract: SPA was more painful than UC, as assessed by brow-bulging, and had a tendency to be associated with a higher rate of procedure failure. These findings should be taken into consideration when choosing between these 2 procedures for preterm infants who undergo urine sampling.

Cited by 37 publications

References 20 publications

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Acute pyelonephritis in children

Intraurethral Lidocaine for Urethral Catheterization in Children: A Randomized Controlled Trial

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