Related Experiment Video
Updated: May 10, 2026
Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
Published on: January 31, 2025
A Randomized Controlled Trial of Ultrasound-Assisted versus Traditional Landmark Lumbar Puncture in the Neonatal and
Osayame A Ekhaguere1, Russell Kesman1, Joseph Reiter1
1Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Objective:
To evaluate whether static ultrasound improves first-attempt, nontraumatic lumbar puncture (LP) success compared with the traditional landmark technique in infants admitted to a neonatal intensive care unit (NICU).
Study Design:
We conducted a prospective, randomized controlled trial at a single tertiary-care NICU between August 2016 and January 2020. Infants ≤6 months of age requiring LP were randomized 1:1 to ultrasound-assisted or traditional landmark LP. The primary outcome was first-attempt, nontraumatic LP success. Secondary outcomes included success within 2 attempts, procedure duration, and antibiotic exposure. Recruitment was terminated early due to the COVID-19 pandemic.
Results:
We analyzed 95 LPs performed in 91 infants by 16 proceduralists. First-attempt nontraumatic success occurred in 50% of LPs in both groups (OR, 1.00; 95% CI, 0.41-2.43; P = 1.00). Other procedural success outcomes did not differ between groups. Procedure time was longer in the ultrasound group (mean 25.9 vs 17.9 minutes; P = .002). Median antibiotic duration was similar (8 days in both groups; P = .74). Ultrasound assistance improved success within 2 attempts among less experienced proceduralists, with diminishing benefit as LP experience increased. Operator ultrasound experience also modified effectiveness, with improved success observed among proceduralists with prior ultrasound exposure.
Conclusions:
Ultrasound assistance did not improve first-attempt nontraumatic LP success compared with the traditional landmark technique in NICU infants. Ultrasound assistance may improve success within 2 attempts among less experienced proceduralists, with effectiveness influenced by both LP and ultrasound experience.
Trial Registration:
ClinicalTrials.gov NCT02918149https://www.
Clinicaltrials:
gov/study/NCT02918149.
