Download PDF
Am J Perinatol
DOI: 10.1055/a-1845-2335
Original Article

Incidence of Traumatic Lumbar Punctures in Neonates and Infants

Harri Sievänen 
1   Injeq Oy, Tampere, Finland
,
Sauli Palmu
2   Department of Pediatrics, and Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University Hospital, Tampere, Finland
,
Juho Kari
1   Injeq Oy, Tampere, Finland
,
Hanna Soukka
3   Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
,
Päivi Lähteenmäki
3   Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
,
Vesa Eskola
2   Department of Pediatrics, and Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University Hospital, Tampere, Finland
› Author Affiliations Funding This study was funded by Injeq Oy, a Finnish startup company that manufactures bioimpedance spinal needle systems for lumbar punctures.
› Further Information
    Permissions and Reprints

Abstract

Objective The objective of this study is to examine factors accounting for the incidence of traumatic lumbar puncture (TLP) in infants younger than 1 year old.

Study Design Retrospective analysis of cerebrospinal fluid (CSF) data from 1,240 neonatal (≤28 days) and 399 infant lumbar puncture (LP) procedures was conducted. Data from two successive LP procedures were obtained from 108 patients. Logistic regression analysis was used to assess factors accounting for the incidence of TLP in the second LP procedure. The following categorical variables were entered into the model: whether the first procedure was traumatic according to criteria of ≥500 and ≥10,000 erythrocytes/µL, whether the LP procedures were performed within a week, and whether the patient was neonatal at the first procedure.

Results The incidences of TLP were 42.9% in neonates and 22.5% in infants for the criterion of ≥500 erythrocytes/µL, and 16.6 and 10.3% for the criterion of ≥10,000 erythrocytes/µL. Compared with a nontraumatic first LP procedure, if the first procedure was traumatic according to the criterion of ≥10,000 erythrocytes/µL, the odds ratio (OR) of TLP in the second procedure was 5.86 (p = 0.006). Compared with a longer time, if the successive procedures were performed within a week, the OR of TLP was 9.06 (p < 0.0001) according to the criteria of ≥500 erythrocytes/µL and 3.34 (p = 0.045) according to the criteria of ≥10,000 erythrocytes/µL. If the patient was neonatal at the first procedure, the OR of TLP at the second puncture was 0.32 (p = 0.031) according to the criterion of ≥500 erythrocytes/µL.

Conclusions The incidence of TLP in neonates is twice as high as that in infants. Successive LP procedures performed within a week and a highly blood-contaminated CSF sample in the first procedure each multiplied the odds of TLP in the second procedure, whereas being a neonate at the time of the first procedure reduced the odds of TLP.

Key Points

  • Traumatic LPs increase diagnostic uncertainty.

  • Traumatic LPs are twice as common in neonates as in infants.

  • Two LPs performed within a week multiplied the odds of traumatic LP.

  • Erythrocyte-based criteria for traumatic LP affect the incidence of TLP.

Keywords

cerebrospinal fluid - erythrocyte count - lumbar puncture - neonatal - pediatric - traumatic

Note

H.S. and J.K. hold shares and are employees of Injeq Oy.




Publication History

Received: 21 January 2022

Accepted: 27 April 2022

Accepted Manuscript online:
06 May 2022

Article published online:
31 May 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial meningitis in infants. Clin Perinatol 2015; 42 (01) 29-45 , vii–viii
    CrossrefPubMedGoogle Scholar
  • 2 Bedetti L, Marrozzini L, Baraldi A. et al. Pitfalls in the diagnosis of meningitis in neonates and young infants: the role of lumbar puncture. J Matern Fetal Neonatal Med 2019; 32 (23) 4029-4035
    CrossrefPubMedGoogle Scholar
  • 3 Bonadio W. Pediatric lumbar puncture and cerebrospinal fluid analysis. J Emerg Med 2014; 46 (01) 141-150
    CrossrefPubMedGoogle Scholar
  • 4 van Karnebeek CDM, Sayson B, Lee JJY. et al. Metabolic evaluation of epilepsy: A diagnostic algorithm with focus on treatable conditions. Front Neurol 2018; 9: 1016
    CrossrefPubMedGoogle Scholar
  • 5 Aleem S, Greenberg RG. When to include a lumbar puncture in the evaluation for neonatal sepsis. Neoreviews 2019; 20 (03) e124-e134
    CrossrefPubMedGoogle Scholar
  • 6 Nigrovic LE, Kuppermann N, Neuman MI. Risk factors for traumatic or unsuccessful lumbar punctures in children. Ann Emerg Med 2007; 49 (06) 762-771
    CrossrefPubMedGoogle Scholar
  • 7 Greenberg RG, Smith PB, Cotten CM, Moody MA, Clark RH, Benjamin Jr DK. Traumatic lumbar punctures in neonates: test performance of the cerebrospinal fluid white blood cell count. Pediatr Infect Dis J 2008; 27 (12) 1047-1051
    CrossrefPubMedGoogle Scholar
  • 8 Glatstein MM, Zucker-Toledano M, Arik A, Scolnik D, Oren A, Reif S. Incidence of traumatic lumbar puncture: experience of a large, tertiary care pediatric hospital. Clin Pediatr (Phila) 2011; 50 (11) 1005-1009
    CrossrefPubMedGoogle Scholar
  • 9 Srinivasan L, Shah SS, Abbasi S, Padula MA, Harris MC. Traumatic lumbar punctures in infants hospitalized in the neonatal intensive care unit. Pediatr Infect Dis J 2013; 32 (10) 1150-1152
    CrossrefPubMedGoogle Scholar
  • 10 Kessler D, Pusic M, Chang TP. et al; INSPIRE LP investigators. Impact of just-in-time and just-in-place simulation on intern success with infant lumbar puncture. Pediatrics 2015; 135 (05) e1237-e1246
    CrossrefPubMedGoogle Scholar
  • 11 Procter C, Buys H, Carrara H, Thomas J. Risk factors for unsuccessful lumbar puncture in children. S Afr Med J 2016; 106 (12) 1230-1235
    CrossrefPubMedGoogle Scholar
  • 12 Lyons TW, Cruz AT, Freedman SB. et al; Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus Study Group. Interpretation of cerebrospinal fluid white blood cell counts in young infants with a traumatic lumbar puncture. Ann Emerg Med 2017; 69 (05) 622-631
    CrossrefPubMedGoogle Scholar
  • 13 Matettore A, Kollmann TR. Traumatic neonatal lumbar punctures: Experience at a large pediatric tertiary care center in Canada. Am J Perinatol 2018; 35 (08) 764-768
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Flett T, Athalye-Jape G, Nathan E, Patole S. Spinal needle size and traumatic neonatal lumbar puncture: an observational study (neo-LP). Eur J Pediatr 2020; 179 (06) 939-945
    CrossrefPubMedGoogle Scholar
  • 15 Bedetti L, Lugli L, Marrozzini L. et al. Safety and success of lumbar puncture in young infants: A prospective observational study. Front Pediatr 2021; 9: 692652
    CrossrefPubMedGoogle Scholar
  • 16 Mijovic H, Sadarangani M. To LP or not to LP? Identifying the etiology of pediatric meningitis. Pediatr Infect Dis J 2019; 38 (6S, Suppl 1) S39-S42
    CrossrefPubMedGoogle Scholar
  • 17 McGuire JL, Zorc J, Licht D, Hodinka RL, Shah SS. Herpes simplex testing in neonates in the emergency department. Pediatr Emerg Care 2012; 28 (10) 949-955
    CrossrefPubMedGoogle Scholar
  • 18 Le Doare K, Menson E, Patel D, Lim M, Lyall H, Herberg J. Fifteen minute consultation: managing neonatal and childhood herpes encephalitis. Arch Dis Child Educ Pract Ed 2015; 100 (02) 58-63
    CrossrefPubMedGoogle Scholar
  • 19 Muthusami P, Robinson AJ, Shroff MM. Ultrasound guidance for difficult lumbar puncture in children: pearls and pitfalls. Pediatr Radiol 2017; 47 (07) 822-830
    CrossrefPubMedGoogle Scholar
  • 20 Olowoyeye A, Fadahunsi O, Okudo J, Opaneye O, Okwundu C. Ultrasound imaging versus palpation method for diagnostic lumbar puncture in neonates and infants: a systematic review and meta-analysis. BMJ Paediatr Open 2019; 3 (01) e000412
    CrossrefPubMedGoogle Scholar
  • 21 Stoller JZ, Fraga MV. Real-time ultrasound-guided lumbar puncture in the neonatal intensive care unit. J Perinatol 2021; 41 (10) 2495-2498
    CrossrefPubMedGoogle Scholar
  • 22 Hart C, Thompson A, Moriarty P. QUESTION 2: Is the lateral decubitus position best for successful paediatric lumbar puncture?. Arch Dis Child 2016; 101 (08) 774-777
    CrossrefPubMedGoogle Scholar
  • 23 Hanson AL, Schunk JE, Corneli HM, Soprano JV. A randomized controlled trial of positioning for lumbar puncture in young infants. Pediatr Emerg Care 2016; 32 (08) 504-507
    CrossrefPubMedGoogle Scholar
  • 24 Baxter AL, Fisher RG, Burke BL, Goldblatt SS, Isaacman DJ, Lawson ML. Local anesthetic and stylet styles: factors associated with resident lumbar puncture success. Pediatrics 2006; 117 (03) 876-881
    CrossrefPubMedGoogle Scholar
  • 25 Marshall ASJ, Sadarangani M, Scrivens A. et al; ‘The NeoCLEAR Collaborative Group’. Study protocol: NeoCLEAR: Neonatal Champagne Lumbar punctures Every time - An RCT: a multicentre, randomised controlled 2 × 2 factorial trial to investigate techniques to increase lumbar puncture success. BMC Pediatr 2020; 20 (01) 165
    CrossrefPubMedGoogle Scholar