Ultrasonographic determination of neonatal spinal canal depth

Arthurs, Owen J.; Murray, Matthew J.; Zubier, Mustafa; Tooley, James E.; Kelsall, W

doi:10.1136/adc.2007.129221

Cited by 25 publications

(24 citation statements)

References 11 publications

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“…Using the previously published MSCD-based formula for neonates, namely, MSCD (mm)=2 W (kg)+7,1 the estimated depth would fall outside the measured range in 217/225 patients (95%), with depth overestimated in all of these cases. However, using our estimated model of MSCD (mm)=0.4 W (kg)+20, the predicted depth was outside the measured SCD range in only 23/225 (10.2%) of cases.…”

Section: Resultsmentioning

confidence: 97%

“…These samples are normally obtained by lumbar puncture (LP), which is routinely conducted at the intervertebral disc space of L3/L4 in the midline. One of the commonest pitfalls for clinicians performing LPs is to insert the spinal needle too deeply, resulting in a ‘traumatic’ tap due to disruption of the venous plexus on the posterior wall of the vertebral canal 1. Such blood contamination of the CSF complicates subsequent laboratory interpretation1 and may even render the results inaccurate or uninformative.…”

Section: Introductionmentioning

confidence: 99%

“…One of the commonest pitfalls for clinicians performing LPs is to insert the spinal needle too deeply, resulting in a ‘traumatic’ tap due to disruption of the venous plexus on the posterior wall of the vertebral canal 1. Such blood contamination of the CSF complicates subsequent laboratory interpretation1 and may even render the results inaccurate or uninformative. Any requirement to repeat an LP results in increased distress for both the patient and their parents.…”

Section: Introductionmentioning

confidence: 99%

“…Ultrasound (US) has previously been used to demonstrate a good correlation between MSCD and weight in a neonatal population. A nomogram and simple formula for predicting individual neonatal MSCD was developed 1. The nomogram was validated in a randomised study, demonstrating that a depth marker on an LP needle prior to insertion can significantly improve LP success rates in premature infants and when the doctor performing the LP is less experienced 2…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Weight-based determination of spinal canal depth for paediatric lumbar punctures

Bailie

Arthurs

Murray

et al. 2013

Archives of Disease in Childhood

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Section: Resultsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Weight-based determination of spinal canal depth for paediatric lumbar punctures

Bailie

Arthurs

Murray

et al. 2013

Archives of Disease in Childhood

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“…Mid spinal canal depth (MSCD) varies significantly between neonates of different weights 3. In adults ultrasonically determining the MSCD increases success rates 4.…”

Section: Introductionmentioning

confidence: 99%

Does estimating the mid-spinal canal depth improve lumbar puncture success rates? a single centre tertiary neonatal care audit

Tolhurst-Cleaver

Nanjundappa

Maddock

2011

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Introduction Lumbar puncture (LP) is part of the neonatal septic screen. A cerebro-spinal fluid (CSF) red blood cell (RBC) count of <500 is required to accurately interpret the CSF white cell count.1 Up to 50% of neonatal CSF samples are blood-stained, with increasing incidence in pre-term infants.2 Mid spinal canal depth (MSCD) varies significantly between neonates of different weights.3 In adults ultrasonically determining the MSCD increases success rates.4 A recent study described a formula to estimate MSCD in neonates.3 Aim To determine if calculated MSCD improves LP success rates. Methods A prospective audit. LPs were performed without and with prior calculation of MSCD. In our primary analysis, a successful tap was defined as CSF obtained with <500 RBCs on cell count. Secondary analysis defined success as obtaining a sample suitable for culture. A multiple regression logistic model was used. We report OR (95% CI). Independent variables were gestational age, weight, operator seniority and whether MSCD was estimated. A 5% level of significance was used. Results Results summarized in table 1; OR compare chance of success with new technique to chance of success without. Abstract PF.20 Table 1Details of results by technique and outcome measure MSCD Total LPs Successful LPs Primary outcome OR (95% CI) Samples for culture Secondary outcome OR (95% CI) No 25 13 0.25 (0.06 to 1.05; p=0.06) 22 0.34 (0.07 to 1.61; p=0.17) Yes 19 5 14 MSCD, mid spinal canal depth; LP, lumbar puncture. Discussion Although neither primary nor secondary results were significant, both showed a trend to decreasing success rates. We show no evidence that estimating MSCD improves success rates, but suggest it may be detrimental. The reason for this is unclear. A randomized trial is required.

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Feasibility of ultrasound‐assisted lumbar punctures performed by pediatric oncologists at the point of care

Shaikh

Arzola

Alexander

et al. 2021

Pediatric Blood & Cancer

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Background: Ultrasound assistance improves success rates and reduces adverse outcomes of lumbar punctures (LPs) among adult patients in the emergency room and the operating room, but has not been evaluated in pediatric patients with cancer.Our objectives were (1) to determine whether pediatric oncologists could perform ultrasound-assisted LPs following a structured teaching curriculum, and (2) to determine the feasibility of recruiting pediatric cancer patients to a clinical trial of this procedure.Methods: Three pediatric oncologists completed a curriculum composed of didactic teaching followed by hands-on workshops. Each learner was evaluated during 20 attempts at three ultrasound tasks using the cumulative sum method. The three pediatric oncologists then performed ultrasound assessments prior to routinely scheduled LPs. Feasibility was defined as ability to perform at least 30 ultrasound-assisted LPs within 6 months. Secondary outcomes were the proportion of successful, bloody, or traumatic LPs, time required, and perceived helpfulness of ultrasound.Results: All three pediatric oncologists achieved competence in the three tasks of ultrasound scanning within 20 evaluated attempts. We recruited 62 patients within 1 month, and 58 underwent an ultrasound-assisted LP. All LPs were successful. Two LPs (4%) had ≥500 red blood cells (RBCs)/µl, and nine (16%) had ≥10 RBCs/µl. Median time to conduct the scan was 1.9 minutes (range 0.8-4.0 minutes). In 37 (64%) of the LPs, ultrasound assistance was considered helpful or very helpful.Conclusions: Pediatric oncologists readily achieved competence in ultrasoundassisted LPs, and ultrasound was commonly perceived as helpful. It is feasible to proceed to a randomized trial of this procedure in pediatric cancer.

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Ultrasonographic determination of neonatal spinal canal depth

Abstract: SCD measurements are easily determined by US in neonates, with good correlation between weight and MSCD.

Cited by 25 publications

References 11 publications

Weight-based determination of spinal canal depth for paediatric lumbar punctures

Weight-based determination of spinal canal depth for paediatric lumbar punctures

Does estimating the mid-spinal canal depth improve lumbar puncture success rates? a single centre tertiary neonatal care audit

Feasibility of ultrasound‐assisted lumbar punctures performed by pediatric oncologists at the point of care

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