Why Is My Newborn Not Urinating?

The birth of a baby comes with a whole bundle of new emotions, especially for first-time parents. With the usual apprehension as to whether they could prove to be good parents and take care of the little life entrusted to them, there also comes along an associated dread as to what to do if something goes awry.

For new parents, getting to know the red flags to watch out for is very important. Remember, with a newborn, it is always better to be on the side of caution. Contact your paediatrician right away if your feel something is not right.

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When your gut instinct tells you that something is off with your precious baby, don't waste any time. Get a medical opinion from a professional as soon as possible. Don't simply ask around your family and friends and hope for the best. Remember, the time you spend discussing the situation could be better spent in solving it. Your baby might be suffering all the while that you sit discussing with your friends.

• Some of the common problems that come across with newborns are: trouble breathing, blood in urine or stool, yellowish skin or paleness and fever. Another problem is when the newborn is sleeping either too much or too little as compared to the usual requirement for their age.
• Red flags that caretakers and parents are advised to look out for include: persistent diaper rash that refuses to go down even after the application of creams, tenderness in and around the belly button, refusing to eat, excessive irritability or crankiness, diarrhoea, constipation, a persistent cold, or not urinating as often as they should.
• Regular urination and passing of stools are important in newborns. Generally, it is a cause for concern if a newborn has not urinated during the first 24 hours after being born. In the first two days after being born, the urine produced by a neonate is quite concentrated. This might also contain chemicals referred to as urates which can make a diaper turn pinkish in colour.
• The first bowel movement, on the other hand, is a sticky greenish black substance called meconium. Passing meconium within the first 24 hours after being born is essential. It is the successful passing of meconium that signals that all is working well with the intestines of the baby. If the meconium is not passed within one day, the failure to do so might be signalling a birth defect leading to a blockage of the intestines.
• A study conducted on 1,000 consecutively-born full-term babies delivered at a hospital assessed the time of passage of the first stool and urine. Of the babies in the study, about 42% had passed their first urine by six hours of postnatal age. By 12 hours, 76% had passed their first urine. About 95% of all the babies in the study had passed their first urine within their first 24 hours after being born.[1]
• Similarly, 96% of the babies had passed meconium within their first 24 hours of life.
• The study suggested that otherwise apparently healthy neonates that had not passed urine and meconium within 12 hours of being born should be closely observed. Those that had not passed urine and meconium even after 24 hours should be investigated for congenital abnormalities that might be impacting their lower gastrointestinal and urinary tracts.[2]
• Typically, a healthy newborn would usually have anything from 6 to 8 wet diapers within 24 hours from the 4th day of their life. Anything lesser than the average can be due to the child being dehydrated. Other signs of dehydration in a newborn are the absence of tears when crying, sunken soft spot at the top of the baby's head, and sunken eyes.
• Another study conducted on 11 male and 8 female preterm newborns using the 4-hour voiding observation led to the finding that the "voiding pattern of male and female preterm neonates was characterised by one void per hour". [3]
• The study came to the conclusion that the voiding pattern in preterm babies as against full-term subjects suggested an increase in the number of instances of interrupted voiding indicative of the "immature behaviour of detrusor-sphincter coordination". [4]
• Moreover, there is generally a higher number of voidings during sleep among preterm newborns as compared to full-term subjects. [5]

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Reasons For A Newborn Not Urinating

A decreased output of urine in an infant might be an indication of some underlying medical issue. It is best to consult with your baby's paediatrician at the earliest possible in such situations.

1. Dehydration

According to the definition by the World Health Organization, dehydration is a condition that results from excessive loss of body water. Vomiting and diarrhoea are the most common causes for dehydration in children.

Usually, infants are more susceptible to dehydration as they have a "higher metabolic rate, inability to communicate their needs or rehydrate themselves, and increased insensible losses". [6]

Dehydration in infants can also be caused by a decreased intake against ongoing losses. At times, infants might turn into fussy eaters, refusing to feed. This decreased intake might contribute to dehydration.

As per the National Center of Biotechnology Information [NCBI], "dehydration is a major cause of morbidity and mortality in infants and young children worldwide". [7]

Signs and symptoms are manifested in the body depending on the patient's degree of dehydration. Dehydration can be categorised as mild - 3% to 5%, moderate - 6% to 10%, and severe - more than 10%. [7.1]

The degree of dehydration between an infant and an older child is different. While an infant can have a total body water [TBW] content of 70%-80% of their body weight, an older child can have a TBW content of 60% of their body weight.[8] Hence, in order to reach the same level of dehydration as an older child, the infant would have to lose comparatively more body weight.

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Signs and symptoms as per the level of dehydration

*In infants, by being oliguric is implied having a condition referred to as 'oliguria', that is, a urine output less than 1.0 millilitre per kilogram of weight per hour for 24 hours.

As per the American Academy of Pediatrics, breastfed infants with mild dehydration should continue to nurse. Fluids that have a high sugar content should be avoided as they might worsen diarrhoea.

For moderate dehydration, oral rehydration solutions are generally recommended.

Severe dehydration, on the other hand, requires a rapid restoration of fluids that might be administered intravenously.

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2. Acute renal failure

According to the NCBI, "Acute renal failure [ARF] is a potentially reversible reduction in the capacity of the kidney to excrete nitrogenous wastes and maintain fluid and electrolyte homoeostasis, which usually occurs over hours to days." [9]

Acute renal failure occurs in about 8% of the neonates that are admitted to neonatal intensive care units.[10] Usually, acute renal failure in an infant is recognised on the basis of a decrease in the amount of urine produced within a 24 hours' duration.

Also, very premature infants tend to have a high sodium excretion rate as compared to full-term babies.

Different clinical conditions in a newborn infant might lead to renal insufficiency. Sepsis is one of the leading causes of renal insufficiency in neonates. [11] Sepsis is a serious condition wherein harmful microorganisms find their way into the bloodstream or other tissues and the body's response which can adversely affect the working of various body organs

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3. Acute kidney injury

While connected with the kidney, like the earlier discussed condition, acute kidney injury is typically defined as an abrupt - often within hours - decrease in the functioning of the kidney. This can be attributed both to impairment or loss of function as well as injury or structural damage. [12]

An under-recognised morbidity of newborns, the incidence of acute renal injury in neonates remains unclear in the absence of a unified definition of AKI in newborns. [13]

Prematurely born infants are more at risk of developing acute kidney injury as they might be born with less than half of the number of nephrons as compared to a full-term baby. The number of nephrons in neonates might range from 300,000 to 1.8 million per kidney. The variability in nephrons can be linked to various genetic as well as foetal environmental factors. [14]

Despite the study of acute kidney injury in critically ill newborns lagging behind that in older population, there has, nonetheless, been an intensification of research in this area in the recent years.

Studies in neonates have suggested that AKI is commonly seen in neonates born with a very low birth weight. Similarly, other conditions that might lead to acute kidney injury in neonates include sepsis and congenital heart disease, among others. [15]

Decreased or no urine output in a newborn must never be taken lightly. Always seek prompt medical attention if your baby has not been soiling their diaper as often as they should be for their age.

Never rely on home remedies or any quick fix solutions in such situations. Your paediatrician knows best. Trust your paediatrician. Get a second opinion if you are not satisfied with the prognosis. Ensure that you always seek advice from a registered medical practitioner only.

Your baby is your responsibility. Don't let them down.