title: Cautionary tales from the neonatal intensive care unit: diapers may mislead urinary output estimation in extremely low birthweight infants.
abstract: OBJECTIVE
  To examine the validity of the weighing of modern polyacrylate diapers to determine urine output in the extremely low birth weight infant nursed in a humidified incubator.
  
  
  METHODS
  Observational study with repeated measures using high-absorbency cellulose/polyacrylate diapers and a humidified incubator in a modeled clinical scenario.
  
  
  METHODS
  A tertiary referral neonatal intensive care unit.
  
  
  METHODS
  Six dry diapers were placed into eight levels of humidity, between 55% and 90% inclusive, in an incubator set at 37 degrees C. Hourly weight increments were recorded. The study was repeated with 5 mL of normal saline added to the diaper to mimic prior urine output. Results were compared by Kruskal-Wallis nonparametric analysis of variance.
  
  
  RESULTS
  Dry diapers increased in weight for each humidity level after 1 hr (p < .05). This was significantly greater at higher humidity. The maximum increase was a median of 3.06 g (range, 2.47-3.31 g) at 85% humidity after 6 hrs. When 5 mL of 0.9% saline had been added, the diaper weight changes depended on environmental relative humidity. At > or = 80% humidity, the diapers continued to gain weight; at 70% or 75% humidity, they did not change weight; and at < or = 65% humidity, the diapers lost weight. Maximal evaporative loss was median 1.11 g (range, 0.8-1.24 g) at 6 hrs in 55% relative humidity.
  
  
  CONCLUSIONS
  The use of diaper weighing in high-humidity infant environments may not be an accurate measure of actual urine output in the extremely low birth weight infant. This study demonstrates the need for caution when interpreting this measure, and we discuss some possible clinical approaches to ameliorate this difficulty.
authors.affiliation: Kaleidoscope Neonatal Intensive Care Unit, John Hunter Children's Hospital, New South Wales, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Amey
authors.forename: Natalie
authors.initials: N
authors.lastname: Butchard
authors.forename: Lynne
authors.initials: L
authors.lastname: Hanson
authors.forename: Denise
authors.initials: D
authors.lastname: Kinross
authors.forename: Marie
authors.initials: M
authors.lastname: Mannion
authors.forename: Justine
authors.initials: J
authors.lastname: Parsons
authors.forename: Ian M R
authors.initials: IM
authors.lastname: Wright
mesh_terms: D000180:Acrylic Resins; D041381:Diapers, Infant; D006801:Humans; D006813:Humidity; D007186:Incubators, Infant; D007230:Infant, Low Birth Weight / Q000502:physiology*; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D009517:New South Wales; D019370:Observation; D015203:Reproducibility of Results; D014554:Urination; D014556:Urine
chemical_list: D000180:Acrylic Resins; C006903:carbopol 940