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Infant LP – Is Sitting or Lateral Recumbent Position Better?

August 1, 2022

Written by Nickolas Srica

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There was no statistically significant difference in adequate cerebrospinal fluid (CSF) collection or rate of traumatic taps for lumbar punctures (LPs) performed on infants <92 days of age when comparing sitting versus lateral recumbent positioning for the procedure.

Why does this matter?
LPs are commonly performed as part of a sepsis workup in infants. Sometimes inadequate CSF is obtained, leading to prolonged hospitalizations and unnecessary antibiotic administration. Also, “traumatic taps” are associated with the procedure, which makes CSF interpretation difficult. Positioning may impact the rate of LP success. Does either a sitting or lateral recumbent position lead to higher success rates or lower complication rates for infant LPs?

Sit up, no lay down, no sit up, no lay down…SNIP SNAP, SNIP SNAP!
This was a retrospective cohort study of infants <92 days old who had a LP performed at a tertiary pediatric ED from January 2017 to November 2019. The primary outcome of adequate CSF collection was determined by all ordered CSF studies successfully being resulted, and there was no statistically significant difference between the two groups (62.9% sitting vs. 57.8% lateral recumbent, p=0.22). The number of LPs in which no CSF was collected also had no statistically significant difference. Secondarily, the proportion of atraumatic LPs, defined as either <500 RBCs (72% sitting vs. 73% lateral recumbent, p=0.83) or <10,000 RBCs (86% sitting vs. 87% lateral recumbent, p=0.60), also yielded no statistically significant difference between positions. Overall, given the retrospective design of this study, with some other limitations, a larger prospective randomized controlled trial would be useful to further explore these findings. For now I think “sticking” with the position you are most comfortable with in this population is an acceptable way to go.

Retrospective study comparing success rates of lumbar puncture positions in infants. Am J Emerg Med. 2022 Jun;56:228-231. doi: 10.1016/j.ajem.2022.04.013. Epub 2022 Apr 12.

What are your thoughts?