Traumatic Neonatal Lumbar Punctures: Experience at a Large Pediatric Tertiary Care Center in Canada

Matettore, Adela; Kollmann, Tobias R.

doi:10.1055/s-0037-1615794

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…This result was the same regardless of the RBC count in the five LPs for which the CSF RBC count was not verified. Although previous reports have shown that older age was related to LP success in this age group [ 10 , 16 ], the present study found no significant association between age and LP success. This finding may be due to the relatively smaller population in our study than in the previous studies.…”

Section: Discussioncontrasting

confidence: 99%

Proportion of Successful Lumbar Punctures in Infants Younger Than Three Months

Miyake,

Ikegawa,

Hataya

et al. 2024

Cureus

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It is important to perform lumbar punctures (LPs) without a single traumatic tap in infants younger than three months owing to the risk of serious complications. The proportion of LPs in which clear cerebrospinal fluid (CSF) was obtained has been previously reported, but some of the procedures involved a traumatic tap. The present study aimed to identify the proportion of LPs in which clear CSF was obtained without a single traumatic tap and the factors associated with successful LPs in infants younger than three months. This retrospective, observational study included children younger than three months who underwent an LP in the pediatric emergency department between April 2018 and March 2021. The primary outcome was the proportion of successful LPs, defined as LPs obtaining clear CSF without a single traumatic tap. Multiple logistic regression analysis was used to identify factors related to successful LPs. Of 126 eligible patients, 121 were included. Among these, 83 (69%) were in the successful group. No factors significantly associated with successful LPs were found. Larger studies based on an accurate definition of successful LPs, such as that provided by this study, are needed to investigate related factors to increase the rate of successful LPs in this age group.

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Section: Discussioncontrasting

confidence: 99%

Proportion of Successful Lumbar Punctures in Infants Younger Than Three Months

Miyake,

Ikegawa,

Hataya

et al. 2024

Cureus

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“…8 These differences and possible selection bias are likely to explain these discordant age-specific incidences. Collating the present and previous findings, 7,13 at least 4 out of 10 neonatal LPs are traumatic to the extent of being visually contaminated by blood.…”

Section: Discussionsupporting

confidence: 79%

“…Without proper sedation, these small patients are inclined to struggle during the procedure, increasing the risk of failed sampling and tissue trauma caused by the spinal needle. Traumatic lumbar punctures (TLPs), defined as a specified count of red blood cells in the CSF sample, are frequent in neonates and infants, [6][7][8][9][10][11][12][13][14][15] affecting 27 to 55% of LPs using 400 to 500 erythrocytes/µL of CSF as a criterion of TLP. [6][7][8]11,13,14 These criteria may vary much between studies from low counts of erythrocytes up to even 10,000 erythrocytes/µL.…”

mentioning

confidence: 99%

“…Traumatic lumbar punctures (TLPs), defined as a specified count of red blood cells in the CSF sample, are frequent in neonates and infants, [6][7][8][9][10][11][12][13][14][15] affecting 27 to 55% of LPs using 400 to 500 erythrocytes/µL of CSF as a criterion of TLP. [6][7][8]11,13,14 These criteria may vary much between studies from low counts of erythrocytes up to even 10,000 erythrocytes/µL. 6,7,12 Variance in the criteria used for this assessment likely explains the variation in reported incidences of TLP, at least partially.…”

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confidence: 99%

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Incidence of Traumatic Lumbar Punctures in Neonates and Infants

Sievänen¹,

Palmu

Kari³

et al. 2022

Am J Perinatol

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Objective: To examine factors accounting for the incidence of traumatic lumbar puncture (TLP) in infants younger than one year old. Study design: Retrospective analysis of cerebrospinal fluid (CSF) data from 1240 neonatal (≤ 28 days) and 399 infant lumbar puncture (LP) procedures. Data from two successive LP procedures were obtained from 108 patients. Logistic regression analysis was used to assess factors accounting for the incidence of TLP in the second LP procedure. The following categorical variables were entered into the model: whether the first procedure was traumatic according to criteria of ≥500 and ≥10000 erythrocytes/µL, whether the LP procedures were performed within a week, and whether the patient was neonatal at the first procedure. Results: The incidences of TLP were 42.9% in neonates and 22.5% in infants for the criterion of ≥500 erythrocytes/µL, and 16.6% and 10.3% for the criterion of according to ≥10000 erythrocytes/µL. Compared to a non-traumatic first LP procedure, if the first procedure was traumatic according to the criterion of ≥10000 erythrocytes/µL, the odds ratio (OR) of TLP in the second procedure was 5.86 (p=0.006). Compared to a longer time, if the successive procedures were performed within a week, the OR of TLP was 9.06 (p<0.0001) according to the criteria of ≥500 erythrocytes/µL and 3.34 (p=0.045) according to the criteria of ≥10000 erythrocytes/µL. If the patient was neonatal at the first procedure, the OR of TLP at the second puncture was 0.32 (p=0.031) according to criterion of ≥500 erythrocytes/µL. Conclusions: The incidence of TLP in neonates is twice as high as in infants. Successive LP procedures performed within a week and a highly blood-contaminated CSF sample in the first procedure each multiplied the odds of TLP in the second procedure, whereas being a neonate at the time of the first procedure reduced the odds of TLP.

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“…[ 4 ] The incidence of traumatic CSF taps in children ranges from 12% to 26% in studies and can be as high as 47.7% amongst neonates. [ 5 6 ] These are affected by the experience of the performer as well as the age and position of the child. Younger neonates tend to have more traumatic punctures due to procedural difficulties.…”

Section: Discussionmentioning

confidence: 99%

Role of neonatal cerebrospinal fluid cytology in correlation to C-reactive protein, blood culture, risk factors and clinical outcomes in neonatal intensive care

Pradhan

Mishra

Panda

et al. 2023

Journal of Family Medicine and Primary Care

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A BSTRACT Introduction: The number of neonatal cerebrospinal fluid (CSF) samples sent from the neonatal intensive care unit (NICU) for cytologic examination is rising, warranting accurate analysis and interpretation of the same. This study was taken up to assess the usefulness of CSF cell count and cytology in NICU settings, as it can be used even in a resource-limited setting. Aim and Objective: 1) To study the prevalence of cell count and cytologic changes in CSF from NICU and assess their usefulness in correlation to C-reactive protein, CSF neutrophil percentage, blood, CSF culture, and other biochemical parameters. 2) To correlate cell counts and cytology with age, period of gestation, presence, and absence of sepsis, seizures, intracranial hemorrhage, and their clinical follow-up. Materials and Methods: A retrospective study was done on neonatal CSF samples submitted for cytology over one year (January–December 2016) in the Department of Pathology. CSF cell counts were retrieved, and cytosmears were reviewed for cellularity, cell type, proportion, and background and correlated with the biochemical, microbiological, and clinicoradiological findings. Results: A total of 213 samples were included with 140 males and 73 females with an age range of 0–28 (mean: 7.3) days. The mean CSF cell count was 5.48/cu.mm (0–90 cells/cu.mm). The most frequent cytologic finding was occasional lymphocytes or acellular CSF (63.9%). The CSF leucocyte count and protein levels showed a significant correlation with s C-reactive protein. The CSF cytology showed a significant correlation between the age of the neonate and blood neutrophil percentage ( P = 0.0158). History of intracranial hemorrhage showed a significantly higher frequency of the presence of red blood cells ( P = 0.0147). Conclusion: Accurate cell counts, cytology of neonatal CSF, and biochemical and microbiological workup can help diagnose and manage neonates in intensive care.

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Traumatic Neonatal Lumbar Punctures: Experience at a Large Pediatric Tertiary Care Center in Canada

Abstract: Nearly half of all CSF samples in the study period were contaminated. Traumatic samples were more common in younger neonates.

Cited by 8 publications

References 18 publications

Proportion of Successful Lumbar Punctures in Infants Younger Than Three Months

Proportion of Successful Lumbar Punctures in Infants Younger Than Three Months

Incidence of Traumatic Lumbar Punctures in Neonates and Infants

Role of neonatal cerebrospinal fluid cytology in correlation to C-reactive protein, blood culture, risk factors and clinical outcomes in neonatal intensive care

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