Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 844 (doi:10.1542/peds.2006-1451)
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LETTER TO THE EDITOR

Factors Associated With Lumbar Puncture Success: In Reply

Amy L. Baxter, MD
Department of Pediatrics
Children’s Hospital of the King’s Daughters
Eastern Virginia Medical School
Norfolk, VA 23501-1980
Department of Pediatrics
Children’s Healthcare of Atlanta
Atlanta, GA 30307

Randall G. Fisher, MD
Daniel J. Isaacman, MD
Department of Pediatrics

Bonnie L. Burke, MS
Epidemiology and Biometry Core

M. Louise Lawson, PhD
Clinical Outcomes, Research, and Epidemiology
Children’s Hospital of the King’s Daughters
Eastern Virginia Medical School
Norfolk, VA 23501-1980

In Reply.—

We thank Drs Molina and Fons for their interest in our article on resident success of lumbar puncture (LP) and for sharing their data regarding the width of the intravertebral space of infants in the sitting versus the supine position. Their ultrasound results may influence the common debate of sitting versus recumbent position.

Position did not remain in our model for efficacy (P = .7) with age <12 weeks as a factor, but we did not analyze for a neonatal cohort. However, we alluded to 1 of 2 studies that examined positioning in neonatal LPs. Gleason et al1 randomly assigned 3 positions to 17 healthy preterm infants: lateral recumbent with flexed neck, lateral recumbent with partial neck extension, and sitting. Transcutaneous PO2 and minute ventilation measurements were least affected in infants in the sitting position. Weisman et al2 conducted a randomized trial of 26 ill neonates in sitting, lateral knee-chest, or lateral without knee-chest positions and found that during the LP, mean transcutaneous oxygen pressure was <50 mmHg for twice as much time in the lateral knee-chest than either of the other 2 positions. All LPs were successful.

Although experienced practitioners rarely miss an LP, the data provided by Molina and Fons demonstrate a rationale for the efficacy of the sitting position for difficult patients. The 2 previously mentioned articles suggest improved safety in the sitting position, at least as compared with the flexed lateral recumbent position. A randomized trial of seated versus lateral decubitus success in neonates by infrequent practitioners would be welcome. Until such data are available, we may find ourselves suggesting a seated position for the very young patient (or resident). Certainly we will ensure that holders are comfortable with the seated-position technique.

Finally, it is a pleasure to receive a letter to the editor that illuminates rather than casts shadows. Thank you for your shared appreciation of this most important procedure.

REFERENCES

  1. Gleason CA, Martin RJ, Anderson JV, Carlo WA, Sanniti KJ, Fanaroff AA. Optimal position for a spinal tap in preterm infants. Pediatrics. 1983;71 :31 –35[Abstract/Free Full Text]
  2. Weisman LE, Merenstein GB, Steenbarger JR. The effect of lumbar puncture position in sick neonates. Am J Dis Child. 1983;137 :1077 –1079[Abstract]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

Related articles in Pediatrics:

Factors Associated With Lumbar Puncture Success: In Reply
Amy L. Baxter, Randall G. Fisher, Daniel J. Isaacman, Bonnie L. Burke, and M. Louise Lawson
Pediatrics 2006 118: 844. [Extract] [Full Text]  




This Article
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