| Background and ObjectiveWith the research progress of urodynamics, it becomes popular to apply urodynamic study to diagnose the low urinary tract function in infants. Urodynamic study is becoming an important means to guide therapy of bladder dysfunction in pediatric clinic practice. However, the development of normal neonatal micturition pattern has not been fully set up, and urodynamic parameters in neonates are also need to be standardization. Furthermore, the definition of normal neonatal bladder function and the standard criteria to diagnose abnormal voiding are still controversial.The voiding pattern of the newboms including full term and premature newboms is still unclear. It is well known that the period of 1-7 days after birth is critical to create a more stable way of voiding. Therefore, it is very important to understand of the voiding pattern of the normal newborn. It is defined that the early newborn indicates anyone who is 1-7 days old. According to gestational age the newborn were divided into full-term newborn, premature newborn and post-term newborn. Most domestic and international studies concern the full-term newboms, the literatures on development of premature newborns are limited. In present study, we have observed and compare the difference of the voiding pattern between the preterm and full term newborns.How to diagnose neonatal bladder dysfunction is difficult in the clinic work. Urodynamics is a gold standard to diagnose the low urinary tract dysfunction. However, it is an invasive test and difficult to widely apply in neonates. Sillen et al has paid an attention to the voiding pattern of 4 hours observation in the newborns older infants. Whether the 4-hour observation is suitable to diagnose the abnormality of early newborns is unclear. Therefore, in order to explore the possibility of using 4 hours voiding observation to evaluate the bladder function in early neonates, we performed present study.The present study has shown that bladder voiding function in premature newborns has not been fully developed, but improves quickly after birth. Central nervous system may involve in the mechanism of urination in premature new born.Materials and Methods1. Materials2.1. Observation times and parametersThe premature early newborns is divided into seven groups (the first day group, the second day group, the third day group, the fourth day group, the fifth day group, the sixth day group, the seventh day group) according to the age. Every one was observed and recording of free voiding pattern in 12 hours (9:00Am-21:00Pm) including 3 continuous periods of observation times were 4 hours (9:00Am-13:00pm; 13:00pm-17:00pm; 17:00pm-21:00pm).The parameters are voiding time (VT), voiding volumes (VV), post-void residual volumes (PRV), state of consciousness at voiding, voiding frequency (VF) per hour, and meanwhile, the quantity of intake milk, liquid within the same time schedule for 12 hours from 9AM to 9PM were recorded. The liquid intake was given according to standards protocol. The diaper weight difference before and after voiding was defined as VV. The PRV was determined by ultrasound within 3 minutes after voiding.Fluids were giving intravenously as follows:Body weight:less than 1.0 kg, on the first day,100-120ml/kg, increased by 10-20ml/kg everyday. At 7th day it increased to 140-160ml/kg.;Body weight:1kg-1.5 kg, on the first days,80-100 ml/kg, increased by 10-20ml/kg everyday. At 7th day it increased to 140-180ml/kg;Body weight between 1.5 kg-2.5 kg, on the first day, needs 60-80ml/kg, increased by 10ml-20ml/kg everyday. At 7th day it increased to 140-160ml/kg;Body weight more than 2.5 kg, on the first day,40-60ml/kg, increased by 10ml-20ml/kg everyday. At 7th day it increased to 120-140ml/kg;2.2. Voiding volumes (VV)At first, the weight the urine mat was weighted by an electronic balances (Shenyang Longteng, LD1102) (accurate to 0.1 g.), and then applied to collect urine on newborns. After voiding taking place, the urine pad was weighted and recorded immediately.2.3. Residual urine volume measurementAfter each voiding we used ultrasound detector (GE, LOGIQ400) to detect the residual urine output immediately. Measured length-diameter, thick bladder diameter and residual urine= length-diameter x thick diameter x width size x 0.5.2.4. Judgment of sleep and waking statusSleep refers to shut his eyes, breathing rules and no movement; Sober refers to open eyes, limb move and torso motion, or more powerful.2. MethodsStatistical analysisData are analyzed using the Statistical Package for Social Sciences software (SPSS, version 13.0). Analysis of variance (ANOVA) was used. The significance level was set at P<0.05 with two tails. ResultsThis research is composed of different day-old observation, recorded voiding 617 times.First, the results of the various parameters of voiding by the observation of 12 hours in all groups were satisfied as follows:1. The results of average voiding volume were compared each other:There is a significant difference between the first day and the sixth day (P< 0.001);2. The results of the average residual urine was compared each other:there is not statistically significant among seven groups (P> 0.05).3. The results of the Voiding frequency (VF) per hour were compared:There is a significant difference between the first day and the third day (P< 0.01);There is a significant difference between the first day and the fourth day (P< 0.01);There is a significant difference between the first day and the fifth day (P< 0.001);There is a significant difference between the second day and the fourth day (P< 0.001);There is a significant difference between the second day and the fifth day (P< 0.001);There is a significant difference between the third day and the sixth day (P< 0.05);There is a significant difference between the third day and the seventh day (P < 0.05);There is a significant difference between the sixth day and the seventh day (P < 0.05);4. Seven days micturition awake rate, respectively 37.18% 33.33%, the percentage 24.03%,26.92%,35%,30.69%,22.54%Second, The result of the various parameters of voiding by the observation of 8 hours all groups was satisfied as following: 1. The results of the average voiding volume were compared each other:There is a significant difference between the first day and the sixth day (P< 0.001);2. The results of the average PRV were compared each other:there is no statistically significant among seven groups (P> 0.05).3. The results of the Voiding frequency (VF) per hour were compared:There is a significant difference between the first day and the fifth day (P< 0.001);There is a significant difference between the first day and the seventh day (P< 0.05);There is a significant difference between the second day and the fifth day (P< 0.01);There is a significant difference between the third day and the fifth day (P< 0.05);There is a significant difference between the fourth day and the fifth day (P< 0.01);There is a significant difference between the sixth day and the seventh day (P <0.05);4. Seven days micturition awake rate, respectively 29.41%,40.67%,21.875%,35.71%,26.92%,25.4%,20.75%。Third, The results of the various parameters of voiding by the observation of 4 hours all groups were satisfied as following.1. The results of the average voiding volume were compared each other:There is no significant difference among seven groups.2. The results of the average PRV were compared each other:There is no statistically significant among seven groups.3. The results of the Voiding frequency (VF) per hour were compared:There is a significant difference between the first day and the fifth day (P< 0.001);There is a significant difference between the first day and the fifth day (P< 0.05);There is a significant difference between the fourth day and the fifth day (P< 0.01);4. Seven days micturition awake, respectively 31.57%,33.33%,22.86%,32%,33.87,%25.64,22.22%。Fourth, We got the result of voiding parameters by three periods of 4h,8h,12h:statistical result shown as follows.1. The results of average VV were compared each other:comparison of three periods in every group:there is no statistically significant among three periods.2. The results of average PRV were compared with each other:comparison of three periods in every group:there is no statistically significant among three periods.3. The results of the Voiding frequency (VF) per hour were compared:There is a significant difference between 4h and 12h in the second day (P<0.01);There is a significant difference between 4h and 12h in the fourth day (P<0.01);There is a significant difference between 8h and 12h in the fourth day (P<0.05);There is a significant difference between 4h and 12h in the fifth day (P<0.01);There is a significant difference between 4h and 12h in the sixth day (P<0.01);In the first day 11 patients were observed in the period from 0.5 to 12.5 h after birth,4 cases have no voiding within 12h. Form the third day we discovered that a phenomenon that these newborn's arms or their legs budges or crying before voiding.ConclusionA big variation of parameter of the average VV,PRV and VF is founded. There are no significant changes on the PRV in seven days.4 hours observation can be used to determine the average VV, average with same results as 12 hours observation. For VF the observation of 4h and 8h does not show inconsistence with that of 12 hours observation. |
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