Arch Dis Child Fetal Neonatal Ed doi:10.1136/archdischild-2011-301475
  • Original articles

Positioning of infants in the neonatal intensive care unit for lumbar puncture as determined by bedside ultrasonography

  1. Müge Alvur3
  1. 1Department of Paediatrics and Child Health, Kocaeli University Faculty of Medicine, Izmit, Turkey
  2. 2Department of Radiology, Kocaeli University Faculty of Medicine, Izmit, Turkey
  3. 3Department of Family Medicine, Kocaeli University Faculty of Medicine, Izmit, Turkey
  1. Correspondence to Selim Öncel, Kocaeli University Faculty of Medicine, Department of Paediatrics and Child Health, Umuttepe Yerleskesi, Izmit, Kocaeli, 41380, Turkey; SelimOncel{at}
  • Received 13 December 2011
  • Accepted 30 April 2012
  • Published Online First 9 June 2012


Realising the paucity of data in the standardisation of the optimal position for lumbar puncture (LP) in hospitalised neonates, we have designed an observational study to measure the interspinous distance in infants in a university hospital setting. The infants were placed in two lateral recumbent and two upright positions (lateral recumbent without flexing the hips, lateral recumbent with maximal hip flexion, sitting without flexing the hips and sitting with maximal hip flexion) with concomitant heart rate (HR), transcutaneous oxygen saturation (OS) and interspinous distance (with ultrasonography) measurements. Having the patient sit with maximal hip flexion provided the largest interspinous space for the grand majority of the infants. Sitting positions with/without flexion have resulted in significant increases in HR with respect to lateral recumbent position without flexion. Although statistically significant drops in OSs have been observed between lateral recumbent and sittting with flexion, lateral recumbent with flexion and sitting without flexion, and lateral recumbent with flexion and sitting with flexion positions; no adverse hypoxic events occurred during positioning. Sitting flexed position, which seems to be sufficiently safe and serve to enhance the success rate of a LP, should be favoured for sick neonates whenever the infant's condition permit a spinal tap.


  • Contributors Selim Öncel designed, co-operated during the study process and wrote the manuscript. Ayla Günlemez contributed to the study design and to the manuscript. She also enrolled and positioned the infants during imaging with ultrasound. Yonca Anık made the imaging (ultrasound) assessments and contributed to the Methods section of the manuscript. Müge Alvur made the statistical calculations and analysis. She also made contributions concerning the integrity of the manuscript.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Research Evaluation Committee of the Kocaeli University Faculty of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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