Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 842-844 (doi:10.1542/peds.2006-1191)

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LETTER TO THE EDITOR

Factors Associated With Lumbar Puncture Success

Agustín Molina, MD
Neonatal Intensive Care Unit

Jaime Fons, MD
Neonatal Unit
Department of Pediatrics
Hospital Clínico
46010 Valencia, Spain

To the Editor.—

We read with great interest the recent article by Baxter et al¹ about the factors associated with lumbar puncture (LP) success. We agree that it is difficult to perform an LP, especially on a preterm newborn. In the hands of experienced professionals, it is almost always successful. However, for residents in training, the probability of a traumatic LP rises.

Over the years, we have achieved good results by using the Cincinnati method,² with early stylet removal and without the referred-to adverse effects.^3,4

As for the factors affecting the success of an LP, Baxter et al mention a lack of knowledge concerning the influence of patient positioning. Using spinal ultrasound,⁵ we performed a study of the subarachnoid space (SS) width in newborns and how the space changed according to the patient’s position. Table 1 displays the characteristics of the newborns studied.

View this table: [in this window] [in a new window]   TABLE 1 Characteristics of the Study Sample

 
Table 1 and Fig 1 show that the SS width is significantly greater (P < .001), according to our statistical study, in the seated rather than in lateral decubitus position. Consequently, we think a seated position makes the success of an LP more likely.

View larger version (76K): [in this window] [in a new window]   FIGURE 1 SS width (sitting versus decubitus).

 
Spinal ultrasound could be a useful tool in an LP and could reduce failures. Sometimes, the ultrasound can determine the distance from skin to the SS, thus resolving the problem of when to remove the LP needle stylet (Fig 2). For this reason, along with others unrelated to LP, it is useful to have an ultrasound device in the neonatal units that can be handled by the neonatologist.

View larger version (119K): [in this window] [in a new window]   FIGURE 2 Comparative photograph: SS in sitting (left) versus decubitus (right).

 
We reiterate our interest in the Baxter et al article for their comments on aspects so frequently encountered in pediatric practice but are not seen to be as important as they deserve.

REFERENCES

1. Baxter AL, Fisher RG, Burke BL, Goldblatt SS, Isaacman DJ, Lawson ML. Local anesthetic and stylet styles: factors associated with resident lumbar puncture success [published correction appears in Pediatrics. 2006;117:1870]. Pediatrics. 2006;117 :876 –881[Abstract/Free Full Text]
2. Bonadio WA. Interpreting the traumatic lumbar puncture. Contemp Pediatr Res Q. 1992;1 :23 –32
3. Halcrow SJ, Crawford PJ, Craft AW. Epidermoid spinal cord tumor after lumbar puncture. Arch Dis Child. 1985;60 :978 –979[Abstract/Free Full Text]
4. McDonald JV, Klump TE. Epidermoid spinal cord tumors caused by lumbar puncture. Arch Neurol. 1986;43 :936 –939[Abstract/Free Full Text]
5. Molina A, Estañ J, Fernández L, Fons J, Paredes C, Brines J. Evaluation of the subarachnoid space in newborns with medular ultrasound. Presented at: XIX Meeting of Perinatal Medicine Society; October 2–4, 2003; San Sebastián, Spain

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PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Molina, A. Articles by Fons, J. Search for Related Content PubMed PubMed Citation Articles by Molina, A. Articles by Fons, J. Related Collections Premature & Newborn Social Bookmarking                         What's this?