The Effect of Lumbar Puncture Position in Sick Neonates

Techniques to increase lumbar puncture success in newborn babies: the NeoCLEAR RCT

“…Our safety analysis showed greater physiological stability (i.e. HR and SpO 2 ) for babies receiving LP in the sitting position than for babies receiving LP in the lying position, and this is similar to earlier reports by Gleason et al 29 and Weisman et al 28 Most other safety and secondary outcomes lacked clinical and statistical significance with respect to differences between the groups.…”

“…Interventions/factors with no consistent evidence of significant benefit were training in LP, 14,15 seniority of practitioner, 9,10,[16][17][18][19] sedation, 18,20 use of local anaesthetic, 9,10,15,18,21,22 formulae for needle insertion depth (except certain subgroup analyses) 23 and ultrasound assistance. [24][25][26] Trials investigating different body position during neonatal LP found that sitting was as safe as lying, [27][28][29] with increased space for LP needles 27,29,30 and equally effective in obtaining CSF availability. 14 In one study, 31…”

Assessment of infant position and timing of stylet removal to improve lumbar puncture success in neonates (NeoCLEAR): an open-label, 2 × 2 factorial, randomised, controlled trial

“…Our safety analyses showed greater physiological stability (saturations and heart rate) for sitting lumbar puncture, corroborating previous observations. 15,16 The median of the lowest recorded saturations was 3% higher in the sitting group than in the lying group; in posthoc analyses, 6•6% of infants in sitting position had oxygen levels below 80%, compared with 14•2% in lying position, with an even wider difference for more premature infants (appendix p 14). Similarly, the mean lowest heart rate was 2•5 bpm higher in the sitting group, which corresponded to fewer infants having bradycardic episodes below 100 bpm in the sitting position (5•0%) compared with lying (8•8%).…”

“…This definition has been used in similar studies, 25,26 because interpretation of white blood cell count becomes less reliable above this threshold. Secondary outcomes were shortterm clinical measures (alternative red blood cell thresholds, CSF appearance, white and red blood cell counts, number of procedures and attempts per infant, proportions with different CSFbased diagnoses, time taken, and infant movement); healthcare resource use (duration of antibiotics and length of stay); and safety metrics (cardiorespiratory stability and adverse event reporting; appendix pp [12][13][14][15]. We planned to assess parental anxiety using a standardised questionnaire, but this analysis was stopped after the pilot phase because of low completion rates.…”

A Randomized Controlled Trial of Positioning for Lumbar Puncture in Young Infants

“…8 In that study, though, patients in the sitting position were more than twice as likely to have CSF obtained on the first attempt, a finding not confirmed here. Weisman et al 22 found that mean transcutaneous oxygen saturation was higher in the sitting position relative to the lateral "knee-chest" position in sick neonates. 20 Nonanatomic differences, such as effects on ventilation, may exist between the lateral and sitting positions.…”