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Ultrasound imaging versus palpation method for diagnostic lumbar puncture in neonates and infants: a systematic review and meta-analysis
  1. Abiola Olowoyeye1,
  2. Opeyemi Fadahunsi2,
  3. Jerome Okudo3,
  4. Oluwakare Opaneye4,
  5. Charles Okwundu5
  1. 1 Department of Neonatology, Children’s Hospital at Montefiore, Bronx, New York, USA
  2. 2 Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
  3. 3 School of Public Health, University of Texas, Houston, Texas, USA
  4. 4 Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts, USA
  5. 5 Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences Stellenbosch University, Tygerberg, Cape Town, South Africa
  1. Correspondence to Dr Abiola Olowoyeye, Department of Neonatology, Children’s Hospital at Montefiore, Bronx, New York, USA; aolowoyeye{at}


Importance Lumbar puncture (LP) failure rates vary and can be as high as 65%. Ultrasound guidance could increase the success of performing LP.

Objective To summarise the evidence on the use of ultrasound guidance versus palpation method for LP.

Data sources We searched computerised databases and published indexes, registries and references identified from bibliographies of pertinent articles without any language restrictions to find studies that compared ultrasound guidance to palpation method for performing an LP.

Study selection Studies were included if they were randomised or quasirandomised trials in neonates and infants that compared ultrasound guidance with palpation method for performing an LP.

Data extraction and synthesis Standardised data collection tool was used for data extraction, and two reviewers independently assessed the quality of the studies

Main outcome(s) and measure(s) The primary outcome was the risk of LP failure, while the risk of traumatic tap, needle redirections/reinsertions and procedure durations were secondary outcomes

Results Data from four studies and 308 participants is included in the analysis. Ultrasound imaging reduced the risk of LP failure, risk ratio of 0.58 (95% CI 0.15 to 2.28), but it was not statistically significant (p=0.44). Ultrasound imaging significantly reduced the risk of a traumatic tap risk ratio of 0.33 (95% CI 0.13 to 0.82) and p=0.02. The included studies had low to moderate quality; the studies differed based on mean age and with variability on outcome definition.

Conclusions and relevance This meta-analysis suggests that ultrasound imaging has no effect in increasing lumbar success but is beneficial in reducing the risk of traumatic taps in neonates and infants.

Trial registration number CRD42017055800.

  • Child
  • Humans
  • Spinal Puncture
  • Ultrasonography

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  • Contributors AO wrote the first draft, and no form of payment was made for the production of this paper. JO and CO performed extensive full text review as well as reviewing the key aspects of the paper. OF and OO were responsible for the assessment of bias and statistical analysis of the paper. All authors listed have contributed sufficiently to the project to be included as authors and, to the best of our knowledge, no conflict of interest, financial or other, exists. We have included acknowledgements after the conclusion statement. Each author listed on the manuscript has seen and approved the submission of this final version of the manuscript. In addition, each author takes full responsibility for the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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