Use of seated positioning device (Smoltap^®) for ultrasound-guided infant lumbar punctures.

IF 2.3 3区医学 Q2 PEDIATRICS

Pediatric Radiology Pub Date : 2025-07-01 Epub Date: 2025-06-09 DOI:10.1007/s00247-025-06291-6

Shimwoo Lee, Joseph Miller

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引用次数: 0

Abstract

Background: Infant lumbar punctures (LPs) frequently fail at bedside and prompt repeat attempts with image guidance. Conventionally, image-guided LPs are performed with ultrasound or fluoroscopy while infants are in lateral flexed position. The procedure requires infants to be either sedated or held manually to maintain stable positioning. A new commercially available positioning device (Smoltap^®) provides an alternative method to secure infants in sitting position without needing to administer sedation.

Objective: To evaluate the effectiveness and safety of an infant positioning device during image-guided LPs as an alternative to the conventional LP technique.

Materials and methods: We conducted a retrospective analysis of image-guided LPs from May 2022 to April 2025, approximately 1.5 years before and after the introduction of an infant positioning device in October 2023 at our institution. The device was used for awake infants stable on room air and with head-to-toe length < 57 cm, per instructions for use. The infants were secured in the device, and LPs were performed with ultrasound guidance. Patient demographics and procedural outcomes of LPs performed with and without the device were compared.

Results: We analyzed 42 LPs performed with the device ("device" group) and 37 LPs performed without ("no device" group). The two groups had similar patient characteristics and rates of prior failed bedside LPs (95% and 86%, respectively, P = 0.17). The success rates of obtaining adequate CSF for microbial culture were comparable between the groups (93% and 84%, P = 0.21). There were no complications in either group. The average procedure duration was also similar (14 min vs 16 min, P = 0.65). There was no statistically significant difference in the proportions of traumatic taps when defined as CSF containing ≥ 10,000 erythrocytes/µL (26% and 16%, P = 0.42). When defined as ≥ 500 erythrocytes/µL, the rates of traumatic taps were significantly different (72% and 42%, P = 0.01). Subgroup analysis of the "no device" group suggested that this difference could be attributed to inclusion of sedated patients in the "no device" group. In the "device" group, no patients received sedation.

Conclusion: Performing image-guided infant LPs with a positioning device is a feasible and safe alternative to the conventional technique with the benefit of not needing to sedate or manually hold infants.

Abstract Image

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使用坐姿定位装置（Smoltap®）进行超声引导下的婴儿腰椎穿刺。

背景：婴儿腰椎穿刺（LPs）经常在床边失败，并提示在图像引导下重复尝试。通常，当婴儿侧屈体位时，图像引导的LPs是通过超声或透视进行的。该程序要求婴儿镇静或手动保持稳定的位置。一种新的市售定位装置（Smoltap®）提供了一种替代方法来确保婴儿处于坐姿，而无需使用镇静。目的：评价图像引导下婴儿定位装置作为传统LP技术的替代方案的有效性和安全性。材料和方法：我们对2022年5月至2025年4月期间的图像引导lp进行了回顾性分析，这是在我们机构于2023年10月引入婴儿定位装置前后约1.5年。结果：我们分析了42例使用该设备（“设备”组）和37例不使用该设备（“无设备”组）的lp。两组患者特征和既往床边LPs失败率相似（分别为95%和86%，P = 0.17）。两组间获得足够CSF用于微生物培养的成功率相当（93%和84%，P = 0.21）。两组均无并发症发生。平均手术时间也相似（14分钟vs 16分钟，P = 0.65）。当CSF中红细胞含量≥10,000 /µL时，创伤性穿刺的比例差异无统计学意义（26%和16%，P = 0.42）。当红细胞/µL≥500时，创伤性龙头发生率差异有统计学意义（72%和42%，P = 0.01）。“无装置”组的亚组分析表明，这种差异可能归因于“无装置”组中纳入了镇静患者。在“装置”组中，没有患者接受镇静。结论：使用定位装置进行图像引导的婴儿lp是一种可行且安全的替代传统技术，其优点是无需镇静或手动抱着婴儿。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Radiology 医学-核医学

CiteScore

4.40

自引率

17.40%

发文量

300

审稿时长

3-6 weeks

期刊介绍： Official Journal of the European Society of Pediatric Radiology, the Society for Pediatric Radiology and the Asian and Oceanic Society for Pediatric Radiology Pediatric Radiology informs its readers of new findings and progress in all areas of pediatric imaging and in related fields. This is achieved by a blend of original papers, complemented by reviews that set out the present state of knowledge in a particular area of the specialty or summarize specific topics in which discussion has led to clear conclusions. Advances in technology, methodology, apparatus and auxiliary equipment are presented, and modifications of standard techniques are described. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.