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

OBJECTIVE: 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. RESULTS: 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. CONCLUSIONS: 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.

Initiating resuscitation before umbilical cord clamping in infants with congenital diaphragmatic hernia: a pilot feasibility trial.

BACKGROUND: Infants with congenital diaphragmatic hernia (CDH) often experience hypoxaemia with acidosis immediately after birth. The traditional approach in the delivery room is immediate cord clamping followed by intubation. Initiating resuscitation prior to umbilical cord clamping (UCC) may support this transition. OBJECTIVES: To establish the safety and feasibility of intubation and ventilation prior to UCC for infants with CDH. To compare short-term outcomes between trial participants and matched controls treated with immediate cord clamping before intubation and ventilation. DESIGN: Single-arm, single-site trial of infants with CDH and gestational age ≥36 weeks. Infants were placed on a trolley immediately after birth and underwent intubation and ventilation, with UCC performed after qualitative CO2 detection. The primary feasibility endpoint was successful intubation prior to UCC. Prespecified safety and physiological outcomes were compared with historical controls matched for prognostic variables using standard bivariate tests. RESULTS: Of 20 enrolled infants, all were placed on the trolley, and 17 (85%) infants were intubated before UCC. The first haemoglobin and mean blood pressure at 1 hour of life were significantly higher in trial participants than controls. There were no significant differences between groups for subsequent blood pressure values, vasoactive medications, inhaled nitric oxide or extracorporeal membrane oxygenation. Blood gas and oxygenation index values did not differ between groups at any point. CONCLUSIONS: Intubation and ventilation prior to UCC is safe and feasible among infants with CDH. The impact of this approach on clinically relevant outcomes deserves investigation in a randomised trial.