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Spinal needle size and traumatic neonatal lumbar puncture: an observational study (neo-LP)


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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Fig. 1


  1. 1.

    Princess Margaret Hospital relocated and retitled ‘Perth Children’s Hospital’ (PCH) in 2018



Lumbar puncture


Cerebrospinal fluid


Corrected gestational age


Neonatal intensive care unit


Princess Margaret Hospital


King Edward Memorial Hospital


Intra-ventricular haemorrhage


Australian and New Zealand Neonatal Network


Interquartile range




Confidence interval


Adjusted odds ratio


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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.

Author information

Dr. Thomas Flett conceptualised and designed the study, curated data, drafted the initial manuscript and reviewed and revised the manuscript. Dr. Athalye-Jape designed the methodology, curated data, supervised research, drafted the initial manuscript and revised the manuscript. Ms. Elizabeth Nathan designed the methodology, provided formal data analysis, drafted the initial manuscript and revised the manuscript. Dr. Sanjay Patole critically reviewed the manuscript for important intellectual content.

Correspondence to Thomas Flett.

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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

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  • Neonatology
  • Lumbar puncture