Safety and Success of Lumbar Puncture in Young Infants: A Prospective Observational Study

Abstract

Objective: This study aims to evaluate safety and success rates of lumbar puncture (LP) and to identify factors associated with adverse events or failure of LP in infants. Methods: This two-center prospective observational study investigated infants younger than 90 days of age who underwent LP. Need for resuscitation oxygen desaturation (SpO₂ < 90%), bradycardia and intraventricular hemorrhage were considered adverse events. LP failed if cerebrospinal spinal fluid was not collected or had traces of blood. Logistic regression analysis was used to evaluate whether corrected gestational age (GA), body weight at LP, position, and any respiratory support during LP affected SpO₂ desaturation or failure of LP. Results: Among 204 LPs, 134 were performed in full-term and 70 in pre-term born infants. SpO₂ desaturations occurred during 45 (22.4%) LPs. At multivariate analysis, lower GA at LP (p < 0.001), non-invasive respiratory support (p 0.007) and mechanical ventilation (p 0.004) were associated with SpO₂ desaturations. Transient, self-resolving bradycardia occurred in 7 (3.4%) infants. Two infants had intraventricular hemorrhage detected within 72 h of LP. No further adverse events were registered. Failure of LP occurred in 38.2% of cases and was not associated with any of the factors evaluated. Conclusions: LP was safe in most infants. Body weight or GA at LP did not affect LP failure. These data are useful to clinicians, providing information on the safety of the procedure.

Keywords: lumbar puncture; meningitis; newborn; pre-maturity; sepsis; very low birth weight.

Figure 1

SpO₂ desaturations (<90%) in 204 infants who had vital signs assessment during LP. SpO2 desaturations are divided according to their severity. HFNC, high-flow nasal cannula; MV, mechanical ventilation; LFNC, low-flow nasal cannula; LP, lumbar puncture; nCPAP, nasal continuous positive airway pressure.^†Cases in which the standardized form indicates “desaturation” but without reporting the degree. Twenty of 204 (10%) of LPs were performed in infants on catecholamine support (dobutamine, dopamine or both). Among 20 LPs, 11 were performed in infants with body weight <1,500 g at the time of LP; 8 infants were on CPAP and 12 on mechanical ventilation. Desaturations occurred in 9 infants on catecholamine support.