Positioning for lumbar puncture in newborn infants

Area of Science:

• Neonatal Medicine
• Pediatric Procedures
• Clinical Effectiveness Research

Background:

• Lumbar puncture (LP) is a common procedure in newborns, yet approximately 50% fail, leading to adverse outcomes.
• The lateral decubitus and sitting positions are commonly used for LP, but their comparative effectiveness is unclear.
• This review assesses the benefits and harms of different positions for LP in newborn infants.

Approach:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
• Included newborn infants up to 46 weeks postmenstrual age undergoing LP.
• Compared lateral decubitus, sitting, and prone positions, analyzing success rates, attempts, and adverse events like bradycardia and oxygen desaturation.

Key Points:

• Compared to the sitting position, the lateral decubitus position showed little difference in first-attempt LP success but likely increased bradycardia and oxygen desaturation.
• The lateral decubitus position may reduce first-attempt success compared to the prone position.
• Limited data exists on total attempts, apnea, and pain, with most participants being term newborns.

Conclusions:

• The sitting position may be preferable to the lateral decubitus position in newborns due to potentially fewer episodes of bradycardia and oxygen desaturation.
• The lateral decubitus position may be less effective than the prone position for first-attempt LP success.
• Further research with validated pain scales is needed to fully understand the impact of different positions on newborn LP outcomes.