Point-of-care ultrasonography for suprapubic bladder aspiration in pediatric patients: A systematic review and meta-analysis.

BACKGROUND

Suprapubic aspiration (SPA) is a reliable method for obtaining urine samples in infants to diagnose urinary tract infections (UTIs). However, when performed blindly, the procedure often has low success rates. The increasing use of point-of-care ultrasound (POCUS) across clinical settings offers the opportunity to guide SPA in real time, potentially improving outcomes. This systematic review and meta-analysis examined whether POCUS guidance increases the success of SPA in infants and neonates compared to blind techniques.

METHODS

A comprehensive search of PubMed, MEDLINE, Web of Science, Cochrane Library, and Google Scholar identified eligible studies that enrolled infants or neonates and compared ultrasound-guided versus blind SPA performed by clinicians (excluding procedures done in radiology departments). Data extraction was conducted independently by two reviewers, and risk of bias was assessed using the Cochrane ROB-2 tool. Statistical analyses were performed in Review Manager, with results presented in forest and funnel plots.

RESULTS

Five studies involving 351 infants and neonates met inclusion criteria. Two were conducted in neonatal intensive care units and three in emergency departments. Pooled analyses showed that POCUS guidance significantly improved first-attempt success rates (OR 19.16, 95% CI: 6.17-59.52, p < 0.00001) and overall success rates (OR 6.50, 95% CI: 2.87-14.73, p < 0.00001) compared with blind SPA. Heterogeneity was low (I² = 18%). Procedure times did not differ significantly between groups (MD 6.59 minutes, 95% CI: 1.10-14.27, p = 0.09). Importantly, no evidence of publication bias was detected.

CONCLUSION

This meta-analysis demonstrates that POCUS guidance substantially enhances both first-attempt and overall success of SPA in infants, making it a highly effective technique for diagnosing UTIs in emergency and critical care contexts. Nevertheless, blind SPA remains a viable option in resource-limited settings, provided that infants are adequately prehydrated.