Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria.
STAR-SIMCharacters Training and Research, Vienna, Austria.
Eur J Pediatr. 2023 Jul;182(7):3083-3091. doi: 10.1007/s00431-023-04972-8. Epub 2023 Apr 19.
The purpose of this prospective ultrasound-based pilot study was to identify the most suitable tibial puncture site for intraosseous (IO) access in term and preterm neonates, describe tibial dimensions at this site, and provide anatomical landmarks for rapid localization. We measured the tibial dimensions and distances to anatomical landmarks at puncture sites A (proximal: 10 mm distal to the tibial tuberosity; distal: 10 mm proximal to the malleolus medialis) and B (chosen by palpation of the pediatrician), in 40 newborns in four weight groups (< 1000 g; 1000-2000 g, 2000-3000 g, and 3000-4000 g). Sites were rejected if they fell short of the assumed safety distance to the tibial growth plate of 10 mm. If both A and B were rejected, puncture site C was determined sonographically at the maximum tibial diameter while maintaining the safety distance. Puncture site A violated the safety distance in 53% and 85% (proximally and distally, respectively) and puncture site B in 38% and 33%. In newborns weighing 3000-4000 g, at median (IQR), the most suitable puncture site at the proximal tibia was 13.0 mm (12.0-15.8) distal to the tuberosity and 6.0 mm (4.0-8.0) medial to the anterior rim of the tibia. The median (IQR) diameters at this site were 8.3 mm (7.9-9.1) (transverse) and 9.2 mm (8.9-9.8) (anterior-posterior). The diameters increased significantly with increasing weight. Conclusion: This study adds concise, practical information on the implementation of IO access in neonatal patients: the tibial dimensions in newborns in four different weight groups and initial data on anatomical landmarks to easily locate the IO puncture site. The results may help implement IO access in newborns more safely. What is Known: • Intraosseous access is a feasible option for emergency administration of vital drugs and fluids in newborns undergoing resuscitation when an umbilical venous catheter is impossible to place. • Severe complications of IO access due to malpositioned IO needles have been reported in neonates. What is New: • This study reports the most suitable tibial puncture sites for IO access and the tibial dimensions, in newborns of four weight groups. • The results can help to implement safe IO access in newborns.
本前瞻性超声引导初步研究的目的是确定在足月和早产儿中进行骨髓腔内（IO）入路最适合的胫骨穿刺部位，描述该部位的胫骨尺寸，并为快速定位提供解剖学标志。我们在 40 名新生儿的四个体重组中测量了胫骨尺寸和到穿刺部位 A（近端：距胫骨结节 10mm 处；远端：距内踝内侧 10mm 处）和 B（由儿科医生触诊选择）的解剖学标志的距离，在 <1000g；1000-2000g，2000-3000g 和 3000-4000g。如果穿刺部位距离胫骨生长板的假定安全距离 <10mm，则会拒绝这些部位。如果 A 和 B 都被拒绝，则通过超声确定最大胫骨直径处的 C 穿刺部位，同时保持安全距离。A 穿刺部位近端和远端分别有 53%和 85%（分别）和 B 穿刺部位 38%和 33%不符合安全距离。在体重为 3000-4000g 的新生儿中，胫骨近端最适合的穿刺部位位于距结节 13.0mm（12.0-15.8）处，距胫骨前缘 6.0mm（4.0-8.0）处。该部位的中位数（IQR）直径为 8.3mm（7.9-9.1）（横径）和 9.2mm（8.9-9.8）（前-后径）。直径随体重的增加而显著增加。结论：本研究提供了有关在新生儿患者中实施 IO 入路的简明实用信息：四个不同体重组新生儿的胫骨尺寸以及易于定位 IO 穿刺部位的解剖学标志的初步数据。结果可能有助于更安全地实施新生儿的 IO 入路。已知：• 骨髓腔内入路是在进行复苏的新生儿中无法放置脐静脉导管时，紧急给予重要药物和液体的可行选择。• 在新生儿中，由于 IO 针位置不当而导致 IO 穿刺严重并发症的报道。新发现：• 本研究报告了在四个体重组的新生儿中最适合进行 IO 入路的胫骨穿刺部位和胫骨尺寸。• 这些结果有助于在新生儿中实施安全的 IO 入路。
