Optimal position during a lumbar puncture (LP): A randomized study in preterm newborns

K. L. Serrao, P. Serrao, R. Marques, J. C. Posada

Research output: Contribution to journalArticle

Abstract

It is well known that clinical deterioration often accompanies an LP performed on preterm newborns. This is a prospective randomized study that evaluated the effects of positioning on 14 healthy preterm newborns (GA 34.0 ± 2.6 wks BW 1.9 ± 0.3 kg). The neonates were placed in either the lateral flexed position (FP) or in the sitting position (SP) with head support and spine flexion. Heart rate (HR), mean blood pressure (MBP), respiratory rate (RR), oxygen saturation (SaO2), and transcutaneous oxygen (TcPO2) and transcutaneous carbon dioxide (TcPCO2) was monitored on all patients before, during and up to 15 minutes after the procedure. A COMFORT scale was used thoughout the LP to evaluate the newbom's alertness, agitation, movement, and facial tension with a score range of 1 to 5 in each category. The maximum total COMFORT score is 20 and the minimum is 4, with a high score indicating a distressed infant. In both positions there was a significant increase in HR and MBP during the LP. Mean TcPO2 significantly decreased in the FP (22.9́10.9,P<0.001) as compared to the SP (10.3±7.7mmHg), however, there were no significant changes in SaO2, mean TcPCO2 or RR in either position. All infants experienced similar levels of distress during the procedure, with the mean COMFORT scores in both the FP (12.6 ± 2.6,P±0.001) and SP (11 ± 3,P<0.001) being significantly elevated compared to baseline prior to LP. It is unlikely that the hypoxemia experienced in the FP was due to hypoventilation as there was no corresponding increase in mean TcPCO2 or RR. The data suggests that V-Q imbalance may be responsible for the decrease in the mean TcPO2 observed in the FP. An elevated MBP and hypoxemia can increase the risk of intracranial hemorrhage in these neonates. The SP may be the optimal position for performing an LP in preterm newborns.

Original languageEnglish (US)
Pages (from-to)16A
JournalJournal of Investigative Medicine
Volume44
Issue number1
StatePublished - Jan 1 1996

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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    Serrao, K. L., Serrao, P., Marques, R., & Posada, J. C. (1996). Optimal position during a lumbar puncture (LP): A randomized study in preterm newborns. Journal of Investigative Medicine, 44(1), 16A.