Neonatal Urinary Tract Infection Clinical Trial
Official title:
A Randomized Controlled Trial: Suprapubic Aspiration Versus Urinary Catheterization in the Neonatal Intensive Care Unit.
Urinary tract infection (UTI) is relatively common in infants, with an occurence rate of up
to 10%.
Analysis of collected urine for the presence of bacteria or fungus is the only way to make a
certain UTI diagnosis. Sterile collection of urine can be achieved in newborn infants by
urinary catheterization (UC) where a catheter is passed through the urethra into the bladder,
suprapubic aspiration (SPA) where a needle is inserted into the bladder through the abdominal
wall, or 'clean catch' where urine is collected into a sterile bottle as the baby urinates
during preparation for UC. The main advantage of SPA is that it bypasses the bacteria that
normally resides in the urethral opening, thus minimizing the risk of contamination. Some
studies have suggested that SPA is better than UC for collecting urine in a sterile fashion
in the neonate due to the difficulty of doing sterile UC in small infants resulting in more
contaminated samples (also called a false-positive urine culture); there is still no clear
best choice. UC is commonly used in many Neonatal Intensive Care Units (NICU) as it is
considered less invasive, can be done by the nursing staff, and generally has a higher chance
of obtaining urine. SPA is a simple and safe alternative and, although it may be more painful
than UC, it is performed more quickly. The reported success rate for SPA is variable, but is
greatly increased when an ultrasound confirms urine in the bladder. The question remains:
what is the best method for sterile collection of urine in neonates? In this study, the
investigators will try to answer this question by collecting urine from neonates using either
ultrasound guided SPA or UC and then comparing the contamination rates between these two
methods.
The investigators hypothesize that SPA will result in less contamination of urine samples.
The investigators also hypothesize that there will be more success in obtaining an adequate
urine sample (0.5 ml) by SPA, and that there will be no difference in associated complication
rates between SPA and UC.
See above and other sections. ;