Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.
Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
Eur J Pediatr. 2023 Oct;182(10):4573-4581. doi: 10.1007/s00431-023-05137-3. Epub 2023 Aug 4.
To analyze the optimal lumbar puncture position in infants. A systematic review and meta-analysis. Infants (age < 1 year). December 2022 in PubMed, Scopus, and Web of Science. Randomized controlled trials focusing on lumbar puncture positions were included. Other lumbar puncture position than standard lateral decubitus position. First puncture success and overall success rate. Secondary outcome was desaturation during puncture and procedure-related harms. Risk of bias 2.0 assessment was performed. Outcomes are reported as risk ratios (RR) with 95% confidence intervals (CI). We screened 225 abstracts, and six studies were included. Four studies compared sitting position, one study head elevated lateral position, and one study prone position to lateral position. Risk of bias was high in two studies. First puncture success rate in sitting position (RR 1.00, CI: 0.78-1.18; 2 studies) and overall success rate in sitting position were similar to lateral position (RR 0.97, CI: 0.87-1.17; 3 studies). First attempt success rate was higher in elevated lateral position (RR 1.48, CI: 1.14-1.92; 1 study) and in prone position (RR 1.09, CI: 1.00-1.17; 1 study). Conclusion: Sitting position seems to be equally effective in terms of first attempt and overall success in lumbar puncture than standard lateral position. Elevated lateral position and prone positions had better first attempt success than standard lateral position, but these were assessed only in one study each and thus further studies in these positions are needed. Trial registration: This review was registered in PROSPERO. ID: CRD42022382953. What is Known: • Success rate in lumbar puncture has been poor and first attempt success rate has varied between 50 to 80% in literature. • Optimal lumbar puncture positions for infants have been debated between sitting and lateral decubitus position mostly. What is New: • This is the first meta-analysis focused on lumbar puncture positions in infants, and it found that sitting position was equal to standard lateral position. • Prone position and head elevated lateral positions had higher first puncture success rates, but these were assessed both only in one study, which creates uncertainty to the finding.
分析婴儿腰椎穿刺的最佳位置。系统评价和荟萃分析。婴儿（年龄<1 岁）。2022 年 12 月在 PubMed、Scopus 和 Web of Science 中检索。纳入了专注于腰椎穿刺位置的随机对照试验。除标准侧卧位以外的其他腰椎穿刺位置。首次穿刺成功率和总体成功率。次要结局为穿刺过程中出现血氧饱和度下降和与操作相关的伤害。采用风险偏倚 2.0 评估。结果以风险比（RR）和 95%置信区间（CI）表示。我们筛选了 225 篇摘要，纳入了 6 项研究。其中 4 项研究比较了坐位、1 项研究比较了头高位侧卧位、1 项研究比较了俯卧位与侧卧位。有 2 项研究的偏倚风险较高。坐位首次穿刺成功率（RR 1.00，CI：0.78-1.18；2 项研究）和总体成功率（RR 0.97，CI：0.87-1.17；3 项研究）与侧卧位相似。头高位侧卧位（RR 1.48，CI：1.14-1.92；1 项研究）和俯卧位（RR 1.09，CI：1.00-1.17；1 项研究）首次尝试成功率较高。结论：在腰椎穿刺中，与标准侧卧位相比，坐位在首次尝试和总体成功率方面似乎同样有效。头高位侧卧位和俯卧位的首次尝试成功率高于标准侧卧位，但这两种方法仅在一项研究中进行了评估，因此需要对这些体位进行进一步研究。试验注册：本综述在 PROSPERO 中注册。ID：CRD42022382953。已知内容：• 腰椎穿刺的成功率一直很差，文献中首次尝试成功率在 50%至 80%之间。• 对于婴儿，最佳的腰椎穿刺位置一直存在争议，主要是在坐位和侧卧位之间。新内容：• 这是第一篇专门针对婴儿腰椎穿刺位置的荟萃分析，结果发现坐位与标准侧卧位相同。• 俯卧位和头高位侧卧位首次穿刺成功率较高，但这两种方法都仅在一项研究中进行了评估，这给研究结果带来了不确定性。
