Year: 2025
Type: article
Study design: Observational Study
Abstract: ## Introduction 50-60% of infant lumbar punctures are initially unsuccessful. Such cases prompt request for image-guided LPs. Conventionally in our practice, LPs had been performed in lateral decubitus position with US or fluoroscopic guidance. Patients were often manually held in position due to high anesthesia risk. To reduce struggling, we began using Smoltap, a device that stabilizes infants in seated position. We report our experience performing US-guided LPs with Smoltap, first in the literature. ## Materials and Methods We retrospectively reviewed image-guided infant LPs from 6/2023-6/2024. Per IFU, Smoltap was used for infants of height 45-57 cm. Topical lidocaine cream was applied pre-procedurally. Patients were secured to Smoltap with head/torso straps. A 22-gauge spinal needle was used to access the thecal sac under US guidance. ## Results 18 infants underwent LPs with Smoltap. Their average age was 15 days and weight 3.6 kg. None were sedated. CSF was obtained in all but one, who subsequently underwent a successful LP under anesthesia in lying position. Average CSF volume was 3 cc. 8 taps were bloody (RBC > 1000/µL). Average procedure duration was 18 minutes. 15 infants underwent conventional LPs (lying position under US/FL guidance), where 3 were unsuccessful and 4 were bloody. There were no complications. ## Discussion Studies indicate sitting is superior to lying position for infant LPs. Oulego-Erroz et al. found sitting position increases interspinous process distance and subarachnoid space on spinal US. A randomized controlled trial by Marshall et al. showed sitting position was associated with higher procedural success rates and fewer desaturations. Our early experience demonstrates that consistent sitting position during US-guided LPs is achievable through Smoltap.
Source: Pediatric Radiology
Authors: Shimwoo Lee, Joseph Miller
Institution: Children's Hospital of Los Angeles
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,190
OpenAlex ID: W4411133443