The incidence of ‘traumatic’ lumbar puncture (LP; CSF red cells > 500/mm) has been reported to be 35–46% in the neonatal period. A traumatic LP incurs challenges in diagnosis and management of the underlying condition and increases the risk of complications. We aimed to assess the benefits of a smaller outer diameter, larger gauge 25G needle in reducing the incidence of traumatic LPs compared with the standard 22G LP needle. This prospective observational study compared data from two consecutive epochs. Epoch 1 (Control, April 2016–October 2016), 22G needle for LP as standard practice. Epoch 2 (Intervention, November 2016–October 2017) 25G needle used for LP. Primary outcome was the incidence of traumatic LP. Multiple logistic regression analyses were conducted adjusting for corrected gestational age (CGA) at LP, proceduralist experience and need for ventilation as an indicator of illness. There were 240 LPs during the study period involving 361 attempts (22G, n = 228; 25G, n = 133). Median gestation at birth (P = 0.617) and CGA at LP (P = 0.163) were comparable. Multivariate analysis revealed lower incidence of traumatic LP using 25G needle (P < 0.001). Incidence of obtaining a successful CSF sample was similar between groups (P = 0.944). Proceduralist experience (P = 0.189) and neonatal illness (P = 0.801) were not significant factors.
Conclusion: Our results showed that traumatic LPs were ~ 50% less common with 25G vs 22G needles while retaining a comparable success rate. Dry taps were more likely among the 25G group.
|What is Known:|
• The incidence of neonatal ‘traumatic’ lumbar puncture (CSF red cells > 500/mm) has been reported to be 35–46%.
• A traumatic lumbar puncture incurs challenges in diagnosis and management of the underlying condition and increases the risk of complications.
|What is New:|
• Multivariate analysis revealed lower incidence of traumatic lumbar puncture using 25G needle (vs 22G).
• Incidence of obtaining a successful CSF sample was similar between groups.
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Princess Margaret Hospital relocated and retitled ‘Perth Children’s Hospital’ (PCH) in 2018
Corrected gestational age
Neonatal intensive care unit
Princess Margaret Hospital
King Edward Memorial Hospital
Australian and New Zealand Neonatal Network
Adjusted odds ratio
Greenberg R, Smith PB, Cotton CM, Moody MA, Clark RH, Benjamin DK (2008) Traumatic lumbar punctures in neonates: test performance of the cerebrospinal fluid white blood cell count. Paediatr Infect Dis J 27(12):1047–1051
Halliday HL (1989) When to do a lumbar puncture in a neonate. Arch Dis Child 64(3):313–316
Wiswell TE, Baumgart S, Gannon CM, Spitzer AR (1995) No lumbar puncture in the evaluation for early neonatal sepsis: will meningitis be missed? Pediatrics. 95(6):803–806
Patel SJ, Saiman L, Stanley M (2010) Antibiotic resistance in NICU pathogens: mechanisms, clinical impact and prevention including antibiotic stewardship. Clin Perinatol 37(3):547–563
Howard SC, Gajjar AJ, Cheng C, Kritchevsky SB, Somes GW, Harrison PL, Ribeiro RC, Rivera GK, Rubnitz JE, Sandlund JT, de Armendi AJ, Razzouk BL, Pui CH (2002) Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia. JAMA 288(16):2001–2007
Oncel et al (2013) Positioning of infants in the neonatal intensive care unit for lumbar puncture as determined by bedside ultrasonography. Arch Dis Child Fetal Neonatal Ed 98:F133–F135
Nigrovic L, Kuppermann N, Neuman M (2007) Risk factors for traumatic or unsuccessful lumbar punctures in children. Ann Emerg Med 49(6):762–771
Doherty CM, Forbes RB (2014) Diagnostic Lumbar Puncture. Ulster Med J 83(2):93–102
Landau R, Ciliberto CF, Goodman SR, Kim-Lo SH, Smiley RM (2001) Complications with 25-gauge and 27-gauge Whitacre needles during combined spinal-epidural analgesia in labour. Int J Obstet Anesth 10(3):168–171
Horlocker TT, Vandermeuelen et al (2018) Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fourth edition). Reg Anesth Pain Med 43(3):263–309
Van Veen JJ, Nokes TJ, Makris M (2009) The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals. Br J Haematol 148:15–25
Horlocker TT, Wedel DJ (1998) Anticoagulation and neuraxial block: historical perspective, anaesthetic implications and risk management. Reg Anesth Pain Med 23:129–134
Engelborghs S et al (2017) Consensus guidelines for lumbar puncture in patients with neurological diseases. Alzheimer’s Dement 8:111–126
Arthurs OJ, Murray M, Zubier M, Tooley J, Kelsall W (2008) Ultrasonographic determination of neonatal spinal canal depth. Arch Dis Child Fetal Neonatal Ed 93:F451–F451
Craig F, Strroant J, Winrow A, Davies H (1997) Depth of insertion of a lumbar puncture needle. Arch Dis Child 77:450
We thank Dr. Ajay Anvekar (neonatal senior registrar), Ms. Jane Bew (QE2 Bacteriology Department), Mr. Damber Shrestha (Neonatal Database Manager), NICU staff, ANZNN NICUs, all patients and their families for their cooperation in this study.
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Communicated by Patrick Van Reempts
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Flett, T., Athalye-Jape, G., Nathan, E. et al. Spinal needle size and traumatic neonatal lumbar puncture: an observational study (neo-LP). Eur J Pediatr (2020). https://doi.org/10.1007/s00431-020-03580-0
- Lumbar puncture