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Safety and Success of Lumbar Puncture in Young Infants: A Prospective Observational Study
Luca Bedetti1,2,3, Licia Lugli2, Lucia Marrozzini4
1PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Insights
Lumbar puncture (LP) is generally safe for infants, though oxygen desaturation can occur in premature infants requiring respiratory support. LP failure rates were not linked to infant factors like weight or gestational age.
Area of Science:
- Pediatric Medicine
- Neurology
- Neonatology
Background:
- Lumbar puncture (LP) is a common diagnostic procedure in infants.
- Understanding the safety and success factors of LP in neonates is crucial for clinical practice.
- Adverse events and failure rates require thorough investigation in this vulnerable population.
Purpose of the Study:
- To evaluate the safety and success rates of lumbar puncture (LP) in infants under 90 days old.
- To identify factors influencing adverse events, such as oxygen desaturation and bradycardia.
- To determine predictors of LP failure, defined by inadequate cerebrospinal fluid collection.
Main Methods:
- A prospective observational study conducted at two centers.
- Inclusion criteria: infants younger than 90 days undergoing LP.
- Data collected on gestational age, body weight, respiratory support, and adverse events (SpO2 < 90%, bradycardia, intraventricular hemorrhage).
Main Results:
- 204 LPs were performed; 22.4% of cases involved oxygen desaturations.
- Lower gestational age and respiratory support (non-invasive or mechanical ventilation) were associated with desaturations.
- LP failure occurred in 38.2% of cases, with no identified associated factors.
Conclusions:
- Lumbar puncture is a safe procedure for the majority of infants.
- Gestational age and respiratory support are linked to transient oxygen desaturations.
- Infant body weight and gestational age did not influence the success rate of LP.
Abstract:
Objective: This study aims to evaluate safety and success rates of lumbar puncture (LP) and to identify factors associated with adverse events or failure of LP in infants. Methods: This two-center prospective observational study investigated infants younger than 90 days of age who underwent LP. Need for resuscitation oxygen desaturation (SpO2 < 90%), bradycardia and intraventricular hemorrhage were considered adverse events. LP failed if cerebrospinal spinal fluid was not collected or had traces of blood. Logistic regression analysis was used to evaluate whether corrected gestational age (GA), body weight at LP, position, and any respiratory support during LP affected SpO2 desaturation or failure of LP. Results: Among 204 LPs, 134 were performed in full-term and 70 in pre-term born infants. SpO2 desaturations occurred during 45 (22.4%) LPs. At multivariate analysis, lower GA at LP (p < 0.001), non-invasive respiratory support (p 0.007) and mechanical ventilation (p 0.004) were associated with SpO2 desaturations. Transient, self-resolving bradycardia occurred in 7 (3.4%) infants. Two infants had intraventricular hemorrhage detected within 72 h of LP. No further adverse events were registered. Failure of LP occurred in 38.2% of cases and was not associated with any of the factors evaluated. Conclusions: LP was safe in most infants. Body weight or GA at LP did not affect LP failure. These data are useful to clinicians, providing information on the safety of the procedure.
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