A Randomized Controlled Trial of Ultrasound-Assisted versus Traditional Landmark Lumbar Puncture in the Neonatal and Infant Population.

Abstract

To evaluate whether static ultrasound improves first-attempt, nontraumatic lumbar puncture (LP) success compared with the traditional landmark technique in infants admitted to a neonatal intensive care unit (NICU). We conducted a prospective, randomized controlled trial at a single tertiary-care NICU between August 2016 and January 2020. Infants ≤6 months of age requiring LP were randomized 1:1 to ultrasound-assisted or traditional landmark LP. The primary outcome was first-attempt, nontraumatic LP success. Secondary outcomes included success within 2 attempts, procedure duration, and antibiotic exposure. Recruitment was terminated early due to the COVID-19 pandemic. We analyzed 95 LPs performed in 91 infants by 16 proceduralists. First-attempt nontraumatic success occurred in 50% of LPs in both groups (OR, 1.00; 95% CI, 0.41-2.43; P = 1.00). Other procedural success outcomes did not differ between groups. Procedure time was longer in the ultrasound group (mean 25.9 vs 17.9 minutes; P = .002). Median antibiotic duration was similar (8 days in both groups; P = .74). Ultrasound assistance improved success within 2 attempts among less experienced proceduralists, with diminishing benefit as LP experience increased. Operator ultrasound experience also modified effectiveness, with improved success observed among proceduralists with prior ultrasound exposure. Ultrasound assistance did not improve first-attempt nontraumatic LP success compared with the traditional landmark technique in NICU infants. Ultrasound assistance may improve success within 2 attempts among less experienced proceduralists, with effectiveness influenced by both LP and ultrasound experience. ClinicalTrials.gov NCT02918149https://www. gov/study/NCT02918149.