Incidence of Traumatic Lumbar Punctures in Neonates and Infants

Harri Sievänen; Sauli Palmu; Juho Kari; Hanna Soukka; Päivi Lähteenmäki; Vesa Eskola

doi:10.1055/a-1845-2335

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(S 01): e103-e108
DOI: 10.1055/a-1845-2335

Original Article

Incidence of Traumatic Lumbar Punctures in Neonates and Infants

Authors

Harri Sievänen

¹Injeq Oy, Tampere, Finland
Sauli Palmu

²Department of Pediatrics, and Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University Hospital, Tampere, Finland
Juho Kari

¹Injeq Oy, Tampere, Finland
Hanna Soukka

³Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
Päivi Lähteenmäki

³Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
Vesa Eskola

²Department of Pediatrics, and Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University Hospital, Tampere, Finland

Abstract

Objectives The objective of this study is to examine factors accounting for the incidence of traumatic lumbar puncture (TLP) in infants younger than 1 year old.

Study Design Retrospective analysis of cerebrospinal fluid (CSF) data from 1,240 neonatal (≤28 days) and 399 infant lumbar puncture (LP) procedures was conducted. Data from two successive LP procedures were obtained from 108 patients. Logistic regression analysis was used to assess factors accounting for the incidence of TLP in the second LP procedure. The following categorical variables were entered into the model: whether the first procedure was traumatic according to criteria of ≥500 and ≥10,000 erythrocytes/µL, whether the LP procedures were performed within a week, and whether the patient was neonatal at the first procedure.

Results The incidences of TLP were 42.9% in neonates and 22.5% in infants for the criterion of ≥500 erythrocytes/µL, and 16.6 and 10.3% for the criterion of ≥10,000 erythrocytes/µL. Compared with a nontraumatic first LP procedure, if the first procedure was traumatic according to the criterion of ≥10,000 erythrocytes/µL, the odds ratio (OR) of TLP in the second procedure was 5.86 (p = 0.006). Compared with a longer time, if the successive procedures were performed within a week, the OR of TLP was 9.06 (p < 0.0001) according to the criteria of ≥500 erythrocytes/µL and 3.34 (p = 0.045) according to the criteria of ≥10,000 erythrocytes/µL. If the patient was neonatal at the first procedure, the OR of TLP at the second puncture was 0.32 (p = 0.031) according to the criterion of ≥500 erythrocytes/µL.

Conclusion The incidence of TLP in neonates is twice as high as that in infants. Successive LP procedures performed within a week and a highly blood-contaminated CSF sample in the first procedure each multiplied the odds of TLP in the second procedure, whereas being a neonate at the time of the first procedure reduced the odds of TLP.

Key Points

Traumatic LPs increase diagnostic uncertainty.
Traumatic LPs are twice as common in neonates as in infants.
Two LPs performed within a week multiplied the odds of traumatic LP.
Erythrocyte-based criteria for traumatic LP affect the incidence of TLP.

Keywords

cerebrospinal fluid - erythrocyte count - lumbar puncture - neonatal - pediatric - traumatic

Full Text

References

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