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

Luca Bedetti,Lucia Marrozzini,Alberto Berardi,Maria F Roversi,Laura Lucaccioni,Federica Leone,Lorenza Baroni,Cecilia Rossi,Alessandro Baraldi,Licia Lugli,Lorenzo Iughetti,Roberto D'Amico

doi:10.3389/fped.2021.692652

Luca Bedetti, Lucia Marrozzini + Show 10 more

Open Access

https://doi.org/10.3389/fped.2021.692652

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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.

Highlights

The gold standard for the diagnosis of bacterial meningitis is a positive cerebrospinal fluid (CSF) culture, usually obtained through a lumbar puncture (LP) [1]
Lumbar Puncture in Young Infants from the United States of America and United Kingdom recommend performing an LP in cases of suspected sepsis and meningitis in neonates and infants [3, 4]
We evaluated the rate of intraventricular hemorrhage (IVH) assessed by ultrasound scans within 72 h of LP

Summary

Introduction

The gold standard for the diagnosis of bacterial meningitis is a positive cerebrospinal fluid (CSF) culture, usually obtained through a lumbar puncture (LP) [1]. The clinical suspicion of meningitis is greater in the presence of seizures, fever, bulging fontanel and abnormal consciousness, but in neonatal age the initial signs are often subtle, in younger infants [2]. Lumbar Puncture in Young Infants from the United States of America and United Kingdom recommend performing an LP in cases of suspected sepsis and meningitis in neonates and infants [3, 4]. A recent study from the United States reported that even in confirmed earlyonset sepsis only ∼80% of full-term infants and ∼40% of very pre-term infants undergo LP [5]

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