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Real-time ultrasound-guided lumbar puncture in the neonatal intensive care unit



To determine the rates of traumatic lumbar puncture (LP) and overall success rates using the real-time ultrasound-guided technique when performed by a neonatal point-of-care ultrasound provider.

Study design

Retrospective observational study of 17 infants in the neonatal intensive care unit who underwent a real-time ultrasound-guided LP between March 2015 and November 2016. Spearman’s correlation was calculated.


The first attempt and overall success rates were 65% and 100%, respectively. The rate of nontraumatic LP was 69%. CSF RBC count was inversely correlated with both PMA (Spearman’s correlation coefficient (rs) = −0.74, p = 0.0017) and weight (rs = −0.74, p = 0.0015) at the time of LP.


This study is the first to provide evidence of high success rates with real-time ultrasound-guided LP when performed by a neonatologist. Our data demonstrate feasibility in neonates over a broad range of weights, including premature infants as small as 750 g.

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Fig. 1: Real-time ultrasound-guided lumbar puncture procedure.
Fig. 2: The real-time ultrasound-guided technique is associated with a high incidence of non-traumatic lumbar punctures.
Fig. 3: Post-menstrual age and weight at the time of lumbar puncture are inversely correlated with CSF RBC count.
Fig. 4: Doppler ultrasound imaging of blood vessels in the region of the lumbar spine.


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Author information




JZS and MVF designed the study and wrote the manuscript. JZS performed the statistical analyses.

Corresponding author

Correspondence to Jason Z. Stoller.

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The authors declare no competing interests.

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Stoller, J.Z., Fraga, M.V. Real-time ultrasound-guided lumbar puncture in the neonatal intensive care unit. J Perinatol 41, 2495–2498 (2021).

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