Trick of the Trade

1. Provide oral intake to the neonate
2. 25 minutes after feeding, clean genitals with soap and water; dry with sterile gauze
3. Give non-pharmacologic analgesia (Pacifier or 2% sucrose syrup)
4. One person holds neonate under the axilla with feet dangling
5. Another person starts bladder stimulation with gentle tapping of the suprapubic area (100 taps/min) and stimulation of lumbar paravertebral zone (light circular massage)
6. Perform steps 4 and 5 for 30 secs at a time, as many times as needed
7. Catch midstream urine sample in a sterile collection container

Study Publication¹

• Study methodology:
  • Prospective feasibility and safety study
  • Single center in Madrid
  • 80 neonates (31 girls and 49 boys)
  • Mean ages: 6.66 day old boys and 6.23 day old girls

• Results:
  • 86% success rate in obtaining urine in
  • Mean time for sample collection: 57 sec
  • Mean time spent collecting samples in males: 60.48 sec
  • Mean time spent collecting samples in females: 52.04 sec

• Limitation: Lack of control group

• Conclusion: Based on a previous study using a vibrating bladder stimulator,² this manual method to obtain midstream urine in newborns is safe, quick, and effective.

Urine collection in neonates is a time-consuming and unpredictable task that requires time and attention. Although a small study, this new technique does not cause discomfort or waste time as is typically the case with catheterized urines and bag collection methods, respectively.

Author information

Salim Rezaie, MD

ALiEM Associate Editor
Clinical Assistant Professor of EM and IM
University of Texas Health Science Center at San Antonio
Founder, Editor, Author of R.E.B.E.L. EM and REBEL Reviews

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