Weight-based determination of spinal canal depth for paediatric lumbar punctures

Bailie, Helen; Arthurs, Owen J.; Murray, Matthew J.; Kelsall, AW

doi:10.1136/archdischild-2013-303793

Cited by 8 publications

(3 citation statements)

References 7 publications

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“…[ 56 , 57 ] As a traumatic LP can complicate the interpretation of CSF, it is helpful to evaluate the mean spinal canal depth (MSCD) using either the following rule MSCD (mm) = 0.4 × weight (kg) + 20 or direct ultrasound imaging. [ 58 ] Direct examination of CSF sample under microscope is mandatory to determine the bacterial type and number per high-power field, providing valuable guidance for empirical antibiotic therapy. The presence of Gram-positive cocci in long chains under microscope may suggest GBS meningitis, and Gram-negative bacilli meningitis caused by E. coli or even extended-spectrum beta-lactamase (ESBL) Enterobacteriaceae , depending on microbial surveillance results at the local institutions.…”

Section: Infectious Work-up Of Neonatal Sepsismentioning

confidence: 99%

Neonatal sepsis: within and beyond China

Dong

Basmaci

Titomanlio

et al. 2020

Chinese Medical Journal

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Section: Infectious Work-up Of Neonatal Sepsismentioning

confidence: 99%

Neonatal sepsis: within and beyond China

Dong

Basmaci

Titomanlio

et al. 2020

Chinese Medical Journal

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“…In paediatric practice, bevelled 22-gauge Quincke spinal needles are commonly used. Distance from skin to subarachnoid space increases with weight and is estimated using the formula: Depth (in millimetres)=0.4×weight+20 5. Use of a non-stylet needle should be avoided for concern that skin epithelial cells could be transplanted into the subarachnoid space, leading to formation of an epidermoid tumour.…”

Section: Technical Backgroundmentioning

confidence: 99%

How to use… lumbar puncture in children

Schulga

Grattan

Napier

et al. 2015

Arch Dis Child Educ Pract Ed

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Lumbar puncture (LP) is a useful diagnostic tool in a wide spectrum of paediatric clinical situations. A common indication is to rule out a serious intracranial infection in a febrile child. Success rate can be optimised by proper positioning, appropriate technique and enhanced operator's skill in performing the procedure. The purpose of this review is to explore the indications and contraindications for performing paediatric LP, to describe the anatomical and physiological knowledge required to maximise success rates and to describe complications and their management. We will also provide advice on requesting various cerebrospinal fluid studies, interpretation of results and clinical situations in which LP may be indicated.

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“…In a brief report of SSW among infants younger than 2 months, a statistically significant difference of uncertain clinical relevance (0.7 mm) occurred between positions. 7 Others have sonographically measured spinal canal diameter 9,12 and subarachnoid cross-sectional area 13 in single positions only.…”

Section: Discussionmentioning

confidence: 99%

Seated Position Does Not Change Lumbar Dimensions Compared With Lateral Position

Long

Uya³

et al. 2020

Pediatr Emer Care

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The infant lumbar puncture (LP) can be a technically challenging procedure. Understanding the anatomical lumbar dimensions may optimize LP conditions. Data from preterm neonates, older children, and adults indicate measurements of the lumbar spine in the seated LP position may be superior when compared with the lateral position. We use point-of-care ultrasound (US) to determine if the seated position, when compared with the lateral decubitus position, significantly affected the lumbar dimensions of infants 12 months or younger presenting to the pediatric emergency department. Methods:We conducted a prospective observational study of a convenience sample of patients 12 months or younger. We used US to obtain 3 still images oriented longitudinally in the midline over the L3 to L4 interspace in the lateral decubitus and seated positions. A US fellowship-trained emergency physician, blinded to patient position, measured interspinous space, subarachnoid space width, and spinal canal depth. We then compared the means of all 3 dimensions in the lateral and seated positions.Results: From 50 subjects, 49 subjects provided 46 evaluable sets of images for each measure. Interspinous space, spinal canal depth, and subarachnoid space width did not differ significantly between positions. Mean differences did not exceed 0.02 cm for any of the measured dimensions. We report no significant differences in the 3 lumbar dimensions at the seated position when compared with the lateral decubitus position. Conclusions:For infants younger than 12 months, sonographic measurements of lumbar dimensions did not differ between the positions commonly used for LP.

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Weight-based determination of spinal canal depth for paediatric lumbar punctures

Abstract: We demonstrate a good correlation between weight and MSCD in a large group of children. Use of the simple formula MSCD (mm)=0.4 W+20 could improve the success rates of lumbar puncture in the paediatric population, but remains to be validated.

Cited by 8 publications

References 7 publications

Neonatal sepsis: within and beyond China

Neonatal sepsis: within and beyond China

How to use… lumbar puncture in children

Seated Position Does Not Change Lumbar Dimensions Compared With Lateral Position

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