A method for urine collection in infants

Diaper Slit Perineal Bag Urine Sampling

OBJECTIVE

Many indications justifiably drive the pediatrician to request a urine sample in order to assess the health status of the incontinent baby or infant. Urine collection by means of an adhesive perineal bag is the most widely used in children who do not control urine emission, despite its inaccurate reflection of bacteriuria. We suggest a novel technique to immediately visualize the micturition event upon occurrence, in attempt to shorten waiting times and exhausting checking and rechecking opaque diapers in order to determine whether the desired sample has finally been delivered.

METHODS

The perineal urine collection bag is pulled through a vertical slit created in the front of the disposable diaper. The bag is now visible at all times.

RESULTS

In general, waiting times appear shortened since the implementation of this practice. Since the adoption of this technique at a number of our clinics, we have not experienced bag displacement as was previously experienced. Forgoing the need to manipulate the diaper and repeatedly awakening irritable infants was gladly welcomed by parents.

CONCLUSIONS

Widespread adoption of the diaper slit technique seems a promising procedure enhancing comfort and facilitating the process of obtaining a urine sample in the incontinent child. Assumptions that this procedure actually shortens waiting times and raises the success rates of sample retrieval remain to be proven by formal comparative trials.

The metabolic response to intravenous medium-chain triglycerides in infants after surgery

OBJECTIVE

The aim of this study was to determine if administration of mixed medium-chain triglycerides (MCT)/long chain triglycerides (LCT) fat emulsion would increase net fat oxidation and if carbohydrate intake would influence net fat oxidation.

STUDY DESIGN

Stable infants receiving total parenteral nutrition were studied after surgery. Respiratory gas exchange was measured by indirect calorimetry and urinary nitrogen excretion by the micro-Kjeldahl method. Intravenous fat (4 g/kg/day) was given as either pure LCT fat emulsion or 50/50 MCT/LCT fat emulsion. Carbohydrate intake was either "high" (15 g/kg/day) or "low" (10 g/kg/day). Four groups of patients were studied: group 1 = LCT and high-carbohydrate; group 2 = LCT and low-carbohydrate; group 3 = MCT/LCT and high-carbohydrate; group 4 = MCT/LCT and low-carbohydrate.

RESULTS

At a carbohydrate intake of 15 g/kg/day, the calories available from glucose exceeded the measured resting energy expenditure (REE), and no differences were seen in either energy expenditure or net fat oxidation between patients receiving LCT and MCT/LCT fat emulsions. However, at a carbohydrate intake of 10 g/kg/day, when glucose calories were less than REE, net fat oxidation was significantly higher in patients receiving MCT/LCT (median, 1.94; range, 1.05-2.24 g/kg/day) compared with patients receiving LCT (median, 0.60; range, -0.09 to 1.35; P =.03).

CONCLUSION

Providing that carbohydrate calories do not exceed REE, partial replacement of LCT by MCT in intravenous fat emulsions can increase net fat oxidation in infants after surgery.

A method comparison study to assess the reliability of urine collection pads as a means of obtaining urine specimens from non-toilet-trained children for microbiological examination

BACKGROUND

In young, non-toilet-trained children, the collection of a urine sample for microbiology can be challenging, with the application of a urine bag being the main method of collection. However, recent research has shown that absorbent pads can be used yielding similar results to bag specimens. However, weaknesses in study design erode confidence in research findings. Therefore, improvements in research design are required to fully evaluate the reliability of pad collection.

AIMS OF THE STUDY

This pilot study sought to test the feasibility of a technique for the collection of concurrent bag/pad urine samples from non-toilet-trained children, and to assess the reliability of urine pads over bags as a collection method for urine specimens for microbiological evaluation.

DESIGN

A pilot, method comparison study.

METHODS

Twenty concurrent bag and pad specimens were collected from non-toilet-trained children, following parental consent. Urine specimens were analysed for presence or absence of white cell count (WBC), and bacterial growth, using standard laboratory methods.

DATA ANALYSIS

The Kappa (kappa) statistics and confidence interval (CI) estimation were used to assess agreement between the two collection methods.

RESULTS

Despite concurrent samples there was a lack of agreement between bag and pad specimens on both main outcome measures. Agreement between bag and pad specimens for the presence of WBC yielded a kappa=0.10 (95% CI: 0.19, 0.39), indicating poor agreement, while a kappa of 0.5 (95% CI: 0.12, 0.88) was calculated for the degree of agreement in bacterial growth reflecting moderate agreement. Differences in proportions of the presence of WBC between bag and pad did not quite reach significance at the 5% level 0.2 (95% CI: 0.00, 0.42, P=0.062). For cultures the difference was calculated as 0.15 (95% CI: 0.05, 0.35, P=0.125).

CONCLUSION

The pilot study demonstrates that concurrent urine samples can be obtained without difficulty. Despite poor to moderate agreement on outcome measures the level of agreement is greater than reported in those other studies, that use non-current methods of urine collection, suggesting an advantage of the concurrent technique. It is recommended that larger scale studies be undertaken using the concurrent collection technique to assess reliability of these findings.

Protein metabolism kinetics in neonates: effect of intravenous carbohydrate and fat

The aim of this study was to determine the effect of different glucose/fat ratios on protein metabolism kinetics in newborn infants receiving total parenteral nutrition (TPN). Eighteen studies were done on 14 infants receiving TPN (weight 3.15 +/- 0.22 kg [mean +/- SEM]; gestational age 37.8 +/- 0.9 weeks; postnatal age 14.0 +/- 3.7 days). There were two study groups. Group A infants (n = 9) received 10.0 g/kg/d of dextrose and 4.0 g/kg/d of fat; group B infants (n = 9) received 19.0 g/kg/d of dextrose and 0.5 g/kg/d of fat. Caloric intake (86 kcal/kg/d) and amino-acid intake (2.5 g/kg/d) were the same in the two groups. There was no difference between the groups with regard to weight, gestational age, and postnatal age. Intravenous diet was constant during the 3-day study period. Timed urinary nitrogen excretion was determined. On day 3 of the study, each infant received a priming dose of 15 mumol/kg of [13C]leucine followed by a 6-hour infusion at 6 mumol/kg/h. Plasma and breath samples were taken at hourly intervals, and CO2 production was measured by indirect calorimetry. Plateau levels of plasma [13C]-alpha Ketoisocaproic acid (KIC) enrichment and expired 13CO2 enrichment were determined by gas chromatograph mass spectrometry. Protein metabolism kinetics were calculated. Results were: nitrogen balance 0.27 +/- 0.01 g/kg/d, total protein flux 10.38 +/- 0.34 g/kg/d, total protein synthesis 9.64 +/- 0.31 g/kg/d, total protein breakdown 7.86 +/- 0.38 g/kg/d, and total protein oxidation/excretion 0.92 +/- 0.04 g/kg/d.(ABSTRACT TRUNCATED AT 250 WORDS)

A new equation to predict the resting energy expenditure of surgical infants

It is essential that adequate calories are provided to newborns to cover their energy expenditure. This is difficult to measure and varies significantly between individuals. The aim of this study was to develop an equation to predict the basal energy requirements of stable surgical infants, using easily measurable parameters. Resting energy expenditure (REE) was measured using computerized open-circuit indirect calorimetry. One hundred twenty-two measurements were made on different days in 46 stable nonventilated infants. The measured REE was 34.41 +/- 0.46 cal/kg/min; (mean +/- SEM). Three body-size measurements correlated significantly with REE (cal/min): weight in kilograms (r = .87; P < .00001), body surface area in square meters (r = .86; P < .00001), and lean body mass in kilograms (r = .81; P < .00001). Five other independent variables correlated significantly with REE (cal/kg/min): heart rate in beats per minute (r = .60; P < .00001), postnatal age in days (r = .49; P < .00001) caloric intake in cal/kg/min (r = .44; P < .00001), gestational age in weeks (r = .43; P < .00001), and rectal temperature in degrees Celsius (r = .19; P = .04). Weight, heart rate, age, gestational age, and temperature were regarded as independent predictor variables of REE for the multiple stepwise regression analysis. Three variables entered this highly significant equation: REE (cal/min) = -74.436 + (34.661 x weight in kg) + (0.496 x heart rate in beats/min) + (0.178 x age in days) (r = .92; F = 230.07; significance, F < .00001).(ABSTRACT TRUNCATED AT 250 WORDS)