Real-time ultrasound-guided lumbar puncture in the neonatal intensive care unit

Objective: To determine the rates of traumatic lumbar puncture (LP) and overall success rates using the real-time ultrasound-guided technique when performed by a neonatal point-of-care ultrasound provider.

Study design: Retrospective observational study of 17 infants in the neonatal intensive care unit who underwent a real-time ultrasound-guided LP between March 2015 and November 2016. Spearman's correlation was calculated.

Results: The first attempt and overall success rates were 65% and 100%, respectively. The rate of nontraumatic LP was 69%. CSF RBC count was inversely correlated with both PMA (Spearman's correlation coefficient (r_s) = -0.74, p = 0.0017) and weight (r_s = -0.74, p = 0.0015) at the time of LP.

Conclusions: This study is the first to provide evidence of high success rates with real-time ultrasound-guided LP when performed by a neonatologist. Our data demonstrate feasibility in neonates over a broad range of weights, including premature infants as small as 750 g.