Comparison of Ultrasound Assisted Versus Palpation Method for Diagnostic Lumbar Puncture in Neonates: A Randomized Control Trial

Abstract

Background Our purpose was to determine the beneficial effect of ultrasound (US) assisted lumbar puncture (UALP) to increase lumbar puncture (LP) success compared with the clinical conventional palpation (CCP) method. Methods This parallel randomized controlled single-center trial was conducted in a Neonatal Intensive Care Unit in a tertiary care Hospital. Neonates >28 weeks requiring LP were enrolled and stratified into two groups ≥34 and <34 weeks gestational age. Prior to study initiation, training under the supervision of a qualified radiologist was undertaken. The primary outcome was successful LP (defined as no dry tap and cerebrospinal fluid RBC <1,000/mm3). Secondary outcomes were time taken for the procedure, US estimation of the point of formation of conus. Results A total of 55 cases were randomized after exclusion out of which 29 cases were assigned to UALP and 26 cases to CCP. There was no difference in the primary outcome of LP success between the UALP group and the CCP group [89.7% vs. 84.6%; difference: 5.1% (95% confidence interval: −12.7% to 22.7%)], p = .57. There was a statistically significant difference in time taken for procedure 81.46 ± 65.21 seconds (mean ± SD) in CCP versus 327.93 ± 128.07 seconds in UALP ( p < .001). Results were similar in both groups (<34 and ≥34 weeks gestational age) if analyzed separately. Conclusion UALP did not improve the successful LP when compared with the CCP method. Time taken for procedure is higher in the UALP group.