The effect of lumbar puncture position in sick neonates
L. E. Weisman, G. B. Merenstein and J. R. Steenbarger
Clinical deterioration has been observed in sick neonates during lumbar
puncture. This study was done to determine if hypoxemia occurred during
lumbar puncture, if hypoxemia was position dependent, if transcutaneous PO2
(TcPO2) monitoring effected hypoxemia, and what possible mechanisms were
involved. Twenty-six neonates received lumbar punctures in either a
standard lateral knee-chest position, sitting position, or modified lateral
without knee-chest position. Care was taken not to extend or flex the neck.
Mean TcPO2 was lower for standard lateral than sitting or modified lateral
positions. The time TcPO2 was under 50 mm Hg was greater for standard
lateral positions than sitting or modified lateral positions. Increased
intraesophageal pressure, in the standard lateral position, suggests
extrathoracic compression of the chest by the abdominal contents. We
recommend lumbar punctures be done in the sitting or modified lateral
position.
