09:06am Friday 20 October 2017

New study investigates positioning for lumbar puncture in children

Another procedure children have trouble sitting still for is lumbar puncture — commonly known as spinal tap. Lumbar puncture often is performed in emergency departments on young children with fevers, particularly newborns. In a lumbar puncture, doctors use a needle to draw cerebrospinal fluid from between the vertebrae at the base of the back to diagnose etiologies of fever and other conditions.

How to best to position lumbar puncture on a small, wiggling child intrigued Alyssa Abo, an assistant clinical professor of pediatrics in the UC Davis School of Medicine. She noticed that, though emergency department doctors do lumbar punctures on pediatric patients routinely, there’s no single accepted best position. 

“From a clinical standpoint it was always striking that there was no standard way in neonates and infants to position children for a lumbar puncture,” Abo said. So, she decided to study it. The study “Positioning for Lumbar Puncture in Children Evaluated by Bedside Ultrasound,” is published in a recent issue of the journal Pediatrics.

In the emergency department, the procedure is performed with the child either sitting up or lying on his or her side. How the patient is positioned is determined by the clinician performing the lumbar puncture at the time of the procedure.

Abo said that the best position for lumbar puncture in children should not just be a function of personal preference — it would allow the physician to most easily and effectively withdraw fluid. Future studies are needed to answer this question.  One potential factor may be how to create the largest space between the vertebrae from which to draw the fluid.

For her study, Abo examined lumbar puncture positioning in 24 male and female patients between 6 weeks and 12 years while a resident at Yale-New Haven Children’s Hospital in New Haven, Conn. She studied a total of five positions for each patient — two with the child seated and three with the child lying down. The positions varied by curvature of the back as well as neck flexion. Bedside ultrasound was used to measure how much space between the vertebrae, or interspinous space, each position achieved.

It turned out that having the child sit up with a curved spine provided the biggest space on ultrasound, Abo said.

“A lot of people are just trained to do it with them lying down. But if you can have someone hold them sitting, they may squirm less,” Abo said. “When they’re lying on their side, infants can twist by moving their shoulder and their pelvis. When sitting, the pelvis is more or less fixed, and there’s less twisting.”

Other study authors include Lei Chen, Patrick Johnston and Karen Santucci, all of either the Section of Pediatric Emergency Medicine in the Department of Pediatrics at Yale-New Haven Children’s Hospital or the Clinical Research Program at Children’s Hospital, Boston.

UC Davis Children’s Hospital is the Sacramento region’s only comprehensive hospital for children. From primary care offices to specialty and intensive care clinics, pediatric experts provide compassionate care to more than 100,000 children each year and conduct research on causes and improved treatments for conditions such as autism, asthma, obesity, cancer and birth defects. For more information, visit the UC Davis Children’s Hospital website.


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