Lee Shimwoo, Miller Joseph
Department of Interventional Radiology, Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, United States.
Pediatr Radiol. 2025 Jun 9. doi: 10.1007/s00247-025-06291-6.
Infant lumbar punctures (LPs) frequently fail at bedside and prompt repeat attempts with image guidance. Conventionally, image-guided LPs are performed with ultrasound or fluoroscopy while infants are in lateral flexed position. The procedure requires infants to be either sedated or held manually to maintain stable positioning. A new commercially available positioning device (Smoltap) provides an alternative method to secure infants in sitting position without needing to administer sedation.
To evaluate the effectiveness and safety of an infant positioning device during image-guided LPs as an alternative to the conventional LP technique.
We conducted a retrospective analysis of image-guided LPs from May 2022 to April 2025, approximately 1.5 years before and after the introduction of an infant positioning device in October 2023 at our institution. The device was used for awake infants stable on room air and with head-to-toe length < 57 cm, per instructions for use. The infants were secured in the device, and LPs were performed with ultrasound guidance. Patient demographics and procedural outcomes of LPs performed with and without the device were compared.
We analyzed 42 LPs performed with the device ("device" group) and 37 LPs performed without ("no device" group). The two groups had similar patient characteristics and rates of prior failed bedside LPs (95% and 86%, respectively, P = 0.17). The success rates of obtaining adequate CSF for microbial culture were comparable between the groups (93% and 84%, P = 0.21). There were no complications in either group. The average procedure duration was also similar (14 min vs 16 min, P = 0.65). There was no statistically significant difference in the proportions of traumatic taps when defined as CSF containing ≥ 10,000 erythrocytes/µL (26% and 16%, P = 0.42). When defined as ≥ 500 erythrocytes/µL, the rates of traumatic taps were significantly different (72% and 42%, P = 0.01). Subgroup analysis of the "no device" group suggested that this difference could be attributed to inclusion of sedated patients in the "no device" group. In the "device" group, no patients received sedation.
Performing image-guided infant LPs with a positioning device is a feasible and safe alternative to the conventional technique with the benefit of not needing to sedate or manually hold infants.
婴儿腰椎穿刺（LP）在床边操作时常常失败，需要在影像引导下迅速进行再次穿刺。传统上，影像引导下的LP是在婴儿侧卧位时使用超声或荧光透视进行的。该操作要求婴儿要么接受镇静，要么手动固定以保持稳定的体位。一种新的市售定位装置（Smoltap）提供了一种替代方法，可将婴儿固定在坐位，而无需给予镇静。
评估一种婴儿定位装置在影像引导下的LP中作为传统LP技术替代方法的有效性和安全性。
我们对2022年5月至2025年4月期间的影像引导下的LP进行了回顾性分析，这大约是我们机构于2023年10月引入婴儿定位装置之前和之后的1.5年。根据使用说明，该装置用于在室内空气中稳定、头到脚长度<57 cm的清醒婴儿。将婴儿固定在装置中，并在超声引导下进行LP。比较了使用和未使用该装置进行LP的患者人口统计学和操作结果。
我们分析了使用该装置进行的42次LP（“装置”组）和未使用该装置进行的37次LP（“无装置”组）。两组患者特征相似，先前床边LP失败率也相似（分别为95%和86%，P = 0.17）。两组中获得足够脑脊液用于微生物培养的成功率相当（93%和84%，P = 0.21）。两组均无并发症。平均操作时间也相似（14分钟对16分钟，P = 0.65）。当将创伤性穿刺定义为脑脊液中红细胞≥10,000个/微升时，创伤性穿刺比例无统计学显著差异（26%和16%，P =
0.42）。当定义为≥500个红细胞/微升时，创伤性穿刺率有显著差异（72%和42%
，P = 0.01）。“无装置”组的亚组分析表明，这种差异可能归因于“无装置”组纳入了接受镇静的患者。在“装置”组中，没有患者接受镇静。
使用定位装置进行影像引导下的婴儿LP是一种可行且安全的传统技术替代方法，其优点是无需对婴儿进行镇静或手动固定。
