Abstract
Toilet training in Western culture starts between 18 and 24 months. At this age, a child is assumed to have procured the competences needed for bladder control. Since the knowledge of reference values of a normal micturition serves as a guide to diagnose urologic pathology, the aim of this systematic review is to obtain a more comprehensive picture of normal voiding pattern in healthy infants, who have not yet reached bladder control. The systematic literature search was performed in two databases. This systematic review was conducted by the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). Twenty-one studies were selected that demonstrate factors associated with voiding pattern. Diuresis, interrupted voiding, post-void residual urine and voiding frequency are parameters decreasing with age. Bladder capacity, the lowest volume triggering micturition, flow rate, voiding volume and the level of awake voiding expand with age.
Conclusion: When evaluating the voiding pattern in infants, the normal evaluation of micturition parameters in healthy normal developing infants must be taken into consideration.
What is Known: • Different voiding parameters in healthy infants who are not yet toilet trained are reported. • Voiding was believed to be induced by a constant bladder volume, while nowadays, it is detected that infants possess a functional spino-pontospinal voiding pathway. |
What is New: • Arousal was detected in less than 60 % of all preterm micturitions, while it was present in more than 90 % of the micturitions of healthy “term” infants. • Voided volume, bladder capacity, and flow rate tend to increase with age. In contrast, voiding frequency, post-void residual urine, and interrupted voiding diminishes with an increasing age. |
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References
Bachelard M, Sillen U, Hansson S, Hermansson G, Jodal U, Jacobsson B (1999) Urodynamic pattern in asymptomatic infants: siblings of children with vesicoureteral reflux. J Urol 162(5):1733–1737, discussion 1737-1738
Bakker E, Wyndaele JJ (2000) Changes in the toilet training of children during the last 60 years: the cause of an increase in lower urinary tract dysfunction? BJU Int 86:248–252
Chen CF, Hsu MC, Shen CH, Wang CL, Chang SC, Wu KG, Wu SC, Chen SJ (2011) Influence of breast-feeding on weight loss, jaundice, and waste elimination in neonates. Pediatr Neonatol 52(2):85–92
Chen Y, Wen JG, Li Y, Li YD, Li ZZ, Konttinen YT (2012) Twelve-hour daytime observation of voiding pattern in newborns <4 weeks of age. Acta Paediatr 101(6):583–586
Duong TH, Jansson UB, Hellstrom AL (2013) Vietnamese mothers’ experiences with potty training procedure for children from birth to 2 years of age. J Pediatr Urol 9(6):808–814
Duong TH, Jansson UB, Holmdahl G, Sillén U, Hellstrom AL (2010) Development of bladder control in the first year of life in children who are potty trained early. J Pediatr Urol 6(5):501–505
Duong TH, Jansson UB, Holmdahl G, Sillen U, Hellstrom AL (2013) Urinary bladder control during the first 3 years of life in healthy children in Vietnam—a comparison study with Swedish children. J Pediatr Urol 9(6 Pt A):700–706
Eregie CO (1998) Observations on urinary frequency in exclusively breastfed neonates. East Afr Med J 75(10):576–578
Fairhurst JJ, Rubin CME, Hyde R, Freeman NV, Williams JD (1991) Bladder capacity in Infants. J Pediatr Surg 26(1):55–57
Fukushima K, Morokuma S, Nakano H (2005) Relationship between eye movement period and micturition in newborn infants differs from that of human fetuses at term. Croat Med J 46(5):781–785
Gladh G, Persson D, Mattsson S, Lindstrom S (2000) Voiding pattern in healthy newborns. Neurourol Urodyn 19(2):177–184
Goellner MH, Ziegler EE, Fomon SJ (1981) Urination during the first three years of life. Nephron 28(4):174–178
Holmdahl G, Hanson E, Hanson M, Hellström A, Hjälmås K, Sillén U (1996) Four-hour voiding observation in healthy infants. J Urol 156(5):1809–1812
Holmdahl G, Hanson E, Hanson M, Hellström AL, Sillén U, Sölsnes E (1998) Four-hour voiding observation in young boys with posterior urethral valves. J Urol 160(4):1477–1481
Ichino M, Igawa Y, Seki S, Ishizuka O, Nishizawa O (2007) Natural history and etiology of high pressure voiding in male infants. J Urol 178(6):2561–2565
Jansson U, Hanson M, Sillén U, Hellström A (2005) Voiding pattern and acquisition of bladder control from birth to age 6 years—a longitudinal study. J Urol 174(1):289–293
Jansson UB, Hanson M, Hanson E, Hellstrom AL, Sillen U (2000) Voiding pattern in healthy children 0 to 3 years old: a longitudinal study. J Urol 164(6):2050–2054
Koyanagi T, Horimoto N, Satoh S, Inoue M, Nakano H (1992) The temporal relationship between the onset of rapid eye movement period and the first micturition thereafter in the human fetus with advance in gestation. Early Hum Dev 30(1):11–19
Largo RH, Stutzle W (1977) Longitudinal study of bowel and bladder control by day and at night in the first six years of life. II: The rôle of potty training and the child's initiative. Dev Med Child Neurol 19(5):607–613
Moher D, Liberati A, Tetzlaff JF, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269
Morokuma S, Fukushima K, Kato K (2013) Relationship between arousal response in newborn infants before micturition and bed-wetting from 5 to 7 years of age. Early Hum Dev 89(12):989–991
Muellner SR (1960) Development of urinary control in children: a new concept in cause, prevention and treatment of primary enuresis. J Urol 84:714–716
Neveus T, von Gontard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, Jorgensen TM, Rittig S, Walle JV, Yeung CK, Djurhuus JC (2006) The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol 176(1):314–324
Olsen LH, Grothe I, Rawashdeh YF, Jorgensen TM (2009) Urinary flow patterns of healthy newborn males. J Urol 181(4):1857–1861
Olsen LH, Grothe I, Rawashdeh YF, Jorgensen TM (2010) Urinary flow patterns in first year of life. J Urol 183(2):694–698
Olsen LH, Grothe I, Rawashdeh YF, Jorgensen TM (2010) Urinary flow patterns in premature males. J Urol 183(6):2347–2352
Roberts DS, Rendell B (1989) Postmicturition residual bladder volumes in healthy babies. Arch Dis Child 64(6):825–828
Sillen U (2004) Bladder function in infants. Scand J Urol Nephrol Suppl 215:69–74
Sillen U, Hjalmas K (2004) Bladder function in preterm and full-term infants-free voidings during four-hour voiding observation. Scand J Urol Nephrol Suppl 215:63–68
Sillen U, Solsnes E, Hellstrom AL, Sandberg K (2000) The voiding pattern of healthy preterm neonates. J Urol 163(1):278–281
Stadtler AC, Gorski PA, Brazelton TB (1999) Toilet training methods, clinical interventions, and recommendations. American Academy of Pediatrics. Pediatrics 103(6 Pt 2):1359–1368
Wen JG, Yang L, Xing L, Wang YL CNJ, Zhang Q (2012) A study on voiding pattern of newborns with hypoxic ischemic encephalopathy. Urology 80(1):196–199
Wen JG, Ren CC, Chen Y, Lu YT, Yang L, Cui LG, Wen L, Jia LH, Li YL, Zhang Q (2014) Free voiding patterns in preterm and full-term newborn infants are different between males and females. Acta Paediatr 103(10):e450–453
Wolffenbuttel K, Kok D, van Mastrigt R, van den Berg E, Nijman R (2001) Measurement of urinary flow rate using ultrasound in young boys and infants. J Urol 166(3):1058–1061
Yeung C, Godley M, Ho C, Ransley P, Duffy P, Chen C, Li A (1995) Some new insights into bladder function in infancy. Br J Urol 76(2):235–240
Yeung CK (1995) The normal infant bladder. Scand J Urol Nephrol Suppl 173:19–23
Zotter H, Sauseng W, Kutschera J, Mueller W, Kerbl R (2006) Bladder voiding in sleeping infants is consistently accompanied by a cortical arousal. J Sleep Res 15(1):75–79
Zotter H, Urlesberger B, Pichler G, Mueller W, Kerbl R (2007) Do wet diapers induce arousals in sleeping infants? Acta Paediatr 96(3):452–453
Zotter H, Sauseng W, Urlesberger B, Mueller W, Pichler G, Kerbl R (2006) Does bladder voiding during sleep and wakefulness change the behavioural state of infants? Acta Paediatr 95(12):1644–1647
Zotter H, Grossauer K, Reiterer F, Pichler G, Mueller W, Urlesberger B (2008) Is bladder voiding in sleeping preterm infants accompanied by arousals? Sleep Med 9(2):137–141
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The authors declare that they have no conflict of interest.
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The first and the last author constructed the search strategy. In a next phase they performed independently screening of the studies. When no consensus was reached, SDW was consulted. Methodological quality assessment was executed by KVdC and AV, supported by GDW in case of disagreement. Afterwards KVdC and AV analyzed the results. Relevant figures and tables were constructed by KVdC. Suggestions on a structured way of reporting results were made by SDW. Textual feedback was given by all authors, each with special attention for a specific alinea. Implementation of feedback was performed by KVdC, under supervision of AV.
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Van der Cruyssen, K., De Wachter, S., Van Hal, G. et al. The voiding pattern in healthy pre- and term infants and toddlers: a literature review. Eur J Pediatr 174, 1129–1142 (2015). https://doi.org/10.1007/s00431-015-2578-5
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DOI: https://doi.org/10.1007/s00431-015-2578-5