Does hypoxemia occur before, during or after lumbar puncture procedure in ill newborns? Our experience in a tertiary health center

Abstract

Introduction: Lumbar puncture (LP) remains an important diagnostic investigation in the septic workup of ill newborns. There is rising concern in its use in all critically ill newborns due to its invasive nature as well as the risk of complications; however, examining the cerebrospinal fluid remains the cornerstone to establishing the diagnosis of meningitis. Methodology: The study design was cross-sectional, and a convenient sampling method was adopted. Thirty-one ill newborns admitted consecutively into the special care baby unit of our institution with diagnosis of sepsis and/or meningitis were recruited from July 2015 to December 2015. Results: There were 11 (35.5%) males and 20 (64.5%) females with male to female of 1:1.8. The mean oxygen saturation (SpO2) 5 min before positioning for LP was normal at 95.1% ± 4.6% however this reduced to 90.9% ± 4.1%, but this progressively improved with the mean value 5 min after repositioning to supine been normal at 96.2% ± 3.0%. The mean SpO2was generally lower in those with LP lasting more than 5 min but it was lowest during the phase of needle insertion (89.8% ± 4.3%). Comparing the SpO2during various phases of LP showed that the extent of desaturation was greatest during the stage of spinal needle insertion, and this was statistically significant with Student's t-test (paired) value = 4.649, df = 30 and P = 0.001. Conclusion: LP in the newborn may be associated with significant hypoxia especially in those with prolonged duration of the procedure; therefore routine oxygen monitoring using the pulse oximeter is advised.