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A Randomized Controlled Trial of Positioning for Lumbar Puncture in Young Infants
Amy L Hanson1, Jeff E Schunk, Howard M Corneli
1From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY; and †Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
Insights
For infants aged 1 to 90 days, neither the lateral nor sitting position significantly improved lumbar puncture (LP) success rates. This study found no difference in success rates or complications between the two positions.
Area of Science:
- Pediatric Emergency Medicine
- Neonatal Procedures
- Clinical Trial Methodology
Background:
- Lumbar puncture (LP) is a common diagnostic procedure in infants.
- The lateral and sitting positions are frequently used for infant LP.
- Evidence comparing the efficacy of these positions is limited.
Purpose of the Study:
- To compare the success rates of lumbar puncture (LP) in infants aged 1 to 90 days when performed in the lateral versus the sitting position.
- To evaluate secondary outcomes including successful LP on the first attempt and the incidence of procedural complications.
Main Methods:
- A randomized controlled trial was conducted in a pediatric emergency department.
- Infants aged 1 to 90 days were randomized to either the lateral or sitting position for LP.
- Successful LP was defined by cerebrospinal fluid collection criteria; data were analyzed using intention-to-treat.
Main Results:
- A total of 167 infants had eligible data for analysis.
- LP success rates were similar between the lateral position (77%) and the sitting position (72%).
- No statistically significant differences were observed in first-attempt success or complication rates between the positions.
Conclusions:
- In infants 1 to 90 days old, the lateral and sitting positions demonstrate comparable success rates for lumbar puncture.
- Neither position offers a significant advantage in terms of procedural success or complications in this age group.
Objective:
The lateral and sitting positions are those most widely used to perform lumbar puncture (LP) in infants. This study sought to compare LP success rates by position. Secondary outcomes were successful LP on the first attempt and rates of procedural complications.
Methods:
Infants aged 1 to 90 days undergoing LP in our pediatric emergency department between June 1, 2012 and October 31, 2013 were randomized to 1 position or the other. Successful LP was defined as collection of cerebrospinal fluid with a red blood cell count of less than 10,000 cells/mm on either of the first 2 attempts. Electronic medical records were reviewed for patient information, cerebrospinal fluid results, and procedural complications. Providers completed a questionnaire detailing their previous LP experience and technique. Primary results were analyzed using the intention-to-treat principle.
Results:
We enrolled 168 infants. Of 167 with data eligible for analysis, 82 (49%) were randomized to the lateral position. There was no statistically significant difference in LP success rate between the lateral (77%, 63/82) and sitting (72%, 61/85) positions (difference, 5.1%; 95% confidence interval, -8.2%-18.3%). There were no significant differences in success on the first LP attempt or the rates of procedural complications.
Conclusions:
Among infants 1 to 90 days of age, this study found no difference in LP success between the lateral and sitting positions.
