ObjectiveMidstream clean-catch urine is an accepted method to diagnose urinary tract infection but is impracticable in infants before potty training. We tested the bladder stimulation technique to obtain a clean-catch urine sample in infants.Materials and methodsWe included 142 infants under walking age who required a urine sample in a cross- sectional study carried out during a 3-months period, from September to November 2014, in the emergency department of the University Children’s Hospital of Nice (France). A technique based on bladder stimulation and lumbar stimulation maneuvers, with at least two attempts, was tested by four trained physicians. The success rate and time to obtain urine sample within 3 minutes were evaluated. Discomfort (EVENDOL score ≥4/15) was measured. We estimated the risk factors in the failure of the technique. Chi-square test or Fisher’s exact test were used to compare frequencies. T-test and Wilcoxon test were used to compare quantitative data according to the normality of the distribution. Risk factors for failure of the technique were evaluated using a multivariate logistic regression model.ResultsWe obtained midstream clean-catch urine in 55.6% of infants with a median time of 52.0 s (10.0; 110.0). The success rate decreased with age from 88.9% (newborn) to 28.6% (>1 y) (p = 0.0001) and with weight, from 85.7% (<4kg) to 28.6% (>10kg) (p = 0.0004). The success rate was 60.8% for infants without discomfort (p<0.0001). Heavy weight and discomfort were associated with failure, with adjusted ORs of 1.47 [1.04–2.31] and 6.65 [2.85–15.54], respectively.ConclusionBladder stimulation seems to be efficient in obtaining midstream urine with a moderate success rate in our study sample. This could be an alternative technique for infants before potty training but further randomized multicenter studies are needed to validate this procedure.

RATIONALE: FPIES is mainly related to cow's milk and manifests as a chronic digestive disease or in its acute form with potentially lifethreatening vomiting/diarrhea/dehydration. The objective of this study is to characterize the clinical features of cow's milk-induced FPIES in children. METHODS: A cohort of patients with FPIES was constituted in French Children's Hospitals (Necker, Paris-Lenval, Nice). Data were collected from medical records including all patients referred for an acute episode of FPIES, and divided into 2 groups according to their tolerance of extensively hydrolysed formula (eHF) or their need to be fed an amino-acid formula (AAF). RESULTS: 49 children were enrolled. Chronic had occurred in 36 (73%), after a median period of 10 days following introduction of milkbased formula. In the whole group, the acute episode occurred at a median age of 4 months. Allergy testing was rarely positive: patch test 21 (51%), skin prick tests 3 (8%), specific IgE 13 (30%). Recovery was observed in 19 (40%) at a median age of 31 months. The eHF group comprised 24 (49%) infants and the AAF one 25 (51%). They exhibited the following significant or trend towards significance differences : number of hospitalizations before diagnosis per patient 0,9 vs 2,7 (p50,02), age of FA diagnosis 4,5 months vs 2,8 (p50,04), food tolerance acquisition 54% vs 24% (p50,02), associated FA 4% vs 48% (p50,0002). CONCLUSIONS: Half infants with milk-induced FPIES do not tolerate eHF, and need to be fed with an AAF, a condition associated with a delayed diagnosis.

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