Skin To Calcaneus Distance In The Neonate

Jose Arena ¹, Jose I Emparanza ^1*, Agustin Noguès ¹ and Amanda Burls ²

¹ Hospital Donostia, Spain
² University of Birmingham, United Kingdom

^* To whom correspondence should be addressed. E-mail: jemparan{at}chdo.osakidetza.net.

Accepted 12 February 2005

Abstract

Background:Current recommendations for obtaining blood from neonates advise avoiding the midline area of the heel and are based on post mortem studies. Because of the potential pain and tissue damage from repeated heel pricking in the same area, we investigated whether the depth from skin to calcaneus is smaller in the midline than at the borders of the heel using modern imaging techniques in vivo.

Methods:One hundred consecutive healthy preterm and 105 consecutive healthy term neonates were studied 48 to 72 hours after delivery. The skin to perichondrium distance (SPD) was measure on two occasions by ultrasound at the external, midline and internal areas of the heel.

Findings:Intraobserver agreement was good. Mean SPD was only 0.2mm less in the midline compared to the external and internal sites. There was no difference in the proportion of measurements less than 3mm at any of the 3 sites. Depth was <3mm in less than 3% of the term and ~20% of the preterm infants. The SPD was not correlated with sex or labour presentation. The only related factor was gestational age. Thirty-eight percent of children less than 33 weeks gestational age had an SPD < 3mm compared to only 8% of preterm infants aged 33 weeks or more. This difference was statistically significant. The difference in the proportion of preterm infant of 33 weeks or more gestational age with an SPD of less than 3mm (8%) was not statistically signifance from that of term infants (3%).

Interpretation:Given the use of automated lancets of 2.2mm length or less, the whole plantar surface of the heel is safe for obtaining blood in term neonates and preterm infants of 33 weeks or more gestational age and would reduce soft tissue damage and pain due to repeated pricking in the same area.

Keywords: calcaneus, heel, newborn, puncture, ultrasonography

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