Pain from suprapubic aspiration versus urethral catheterization in neonates and infants ≤6 months: A systematic review and meta-analysis
Bibliographic record
Abstract
ABSTRACT Background The evaluation of suspected late-onset sepsis in neonates and infants ≤6 months includes obtaining a sterile urine sample. Two techniques are used interchangeably in clinical practice to detect the presence of microorganisms: suprapubic aspiration (SPA) and urethral catheterization (UC). At present, it is unclear which method causes more pain. The primary objective of this systematic review and meta-analysis is to determine which technique is more painful. Methods Electronic databases were searched for relevant randomized and quasi-randomized trials in September 2023. The literature search was updated in June 2025 and no additional eligible articles were identified for inclusion. Title and abstract screening, followed by data extraction, were performed in duplicate. The risk of bias was assessed using Cochrane’s risk of bias (RoB) 2.0 tool. The critically important outcome was pain measured using validated tools including unidimensional (behavioural) and multidimensional (combination of behavioural and physiological components) tools. Secondary outcomes included procedure success, procedure duration, and adverse events. Pooled effects estimates were standardized mean difference (SMD), mean difference (MD), and relative risk (RR) with 95% confidence intervals (CI) from random effects meta-analyses. Certainty assessment was completed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Results Of the seven included studies, five studies reported pain scores among 378 infants. Clinical heterogeneity was noted across the studies specifically differences in postnatal age, procedure details (e.g., operator skillset, use of anesthetic and analgesic, ultrasound guidance), and pain assessment tools (unidimensional vs. multidimensional pain scores). There was no difference in pain score for overall procedure for SPA versus UC (SMD 0.25 [95% CI –0.63, 1.14], I2 = 84%; n = 330) and duration of cry (MD 5.26 [95% CI –43.72, 54.23], I2 = 97%; n = 245). The quality of evidence was low for these outcomes. There was a statistically significant difference in procedure duration when SPA was compared to UC (MD –62.62 [95% CI –112.96, –12.27], I2 = 96%; n = 299) with SPA being the procedure of shorter duration. The quality of evidence for this outcome was moderate. None of the studies reported any serious adverse events. Discussion There is insufficient evidence to recommend one technique over the other for reducing pain in infants ≤6 months. Healthcare professionals can select SPA or UC based on the unit preference, skillset, and available resources. Future research is required to inform clinical practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.033 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.023 | 0.040 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".