Develop. Med. Child Neurol. 1979, 21, 483-487
Incidence and Effect of Traumatic Lumbar Puncture in the Neonate Richard L. Schreiner Martin B . Kleiman
Introduction Lumbar puncture is frequently required to diagnose meningitis or intracranial hemorrhage in the neonate. There is controversy concerning the optimum method for the procedure, as well as the effect of traumatic lumbar puncture on the cerebrospinal fluid (CSF) cell count in subsequent spinal taps. Choremis et af. (1956), Shaywitz (1973) and Batnitzky et af. (1977) have associated the use of a needle without a stylet with the development of spinal epidermoid tumors. Others recommend using needles without stylets for lumbar puncture, claiming that the procedure is easier to perform and less likely to be traumatic (Greensher et af. 1971). It is postulated that blood introduced into the CSF during a traumatic lumbar puncture may result in a pleocytosis in subsequent spinal taps. The purposes of this study were: (1) to determine the incidence of non-traumatic, traumatic and unsuccessful lumbar punctures performed with different types of needles in the neonatal period and (2) to determine the effect of a traumatic puncture on CSF white blood-cell response in subsequent spinal taps.
1977, all lumbar punctures performed in the James Whitcomb Riley Hospital Newborn Intensive Care Unit were prospectively evaluated. Indications for the procedure were determined by the house staff and attending physicians caring for the infants and did not involve the authors of the present study. The following information was collected: patient’s name; birthweight; age; gestational age, estimated by physical examination; indication for lumbar puncture; infant’s diagnosis; result of CSF cellcount, glucose, protein, gram stain and culture; physician performing spinal tap; type of needle used; and a description of the gross appearance of the fluid. Each physician chose the type of needle with which they felt most confident. The CSF cell-count was performed within one hour of the spinal tap, using a standard counting chamber. The CSF white blood-cell differential count was performed by examination of a Wright stained smear, prepared by means of a cell centrifuge (Cytospin, Shandon Southern Instruments, Sewickley, Pennsylvania). Of the 435 patients admitted to the Newborn Intensive Care Unit during the period of study, 199 underwent lumbar puncture. Complete information was available on 181 of these 199 infants, who
Material and Method From 18th January 1977 to 18th July ~
Correspondence to Richard L. Schreiner, M.D., Department of Pediatrics, Indiana University School of Medicine, 1100 West Michigan Street, Indianapolis, Indiana 46223.
483
DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY.
1979, 21
Rutherford, New Jersey).
underwent a total of 246 lumbar punctures. Patients with central nervous system infection were excluded from the study. The age of the infants ranged from 0 to 150 days (mean 7.3 days) at the time of the initial puncture. A lumbar puncture was defined as traumatic when 5000 or more red bloodcells ( R B C ) were / ~ ~ present ~ in the third tube of CSF collected, and there was no clinical evidence (falling hematocrit, seizures, bulging fontanelle) or laboratory evidence (computerized axial tomography) of intracranial hemorrhage. This, of course, would not differentiate a traumatic lumbar puncture from a very mild subarachnoid hemorrhage. The procedure was considered unsuccessful when spinal fluid was not obtained. The study of the effect of traumatic lumbar puncture on the CSF cellular response in subsequent taps was based upon data from patients in whom two punctures were performed within a 15-day period and in whom there was no evidence of central nervous system infection or hemorrhage. There were 17 patients in this category. Needles used to perform lumbar punctures included a 22-gauge, 1%-inch LP needle with a stylet (Pharmaseal Laboratories, Glendale, California), a 23-gauge butterfly infusion needle (Abbott Hospitals, Inc., N. Chicago, Illinois), and a standard 23-gauge, 3/4-inch venipuncture needle (Becton-Dickinson,
Results Of the 177 lumbar punctures attempted with a 22-gauge needle with a stylet, 54.2 per cent were non-traumatic, 22 per cent were traumatic and 23.7 per cent were unsuccessful (Table I). Of the 59 attempts with a 23-gauge butterfly needle without a stylet, 54-2 per cent were non-traumatic, 30.5 per cent were traumatic and 15.3 per cent were unsuccessful. Of the 53 attempts with a standard 23-gauge needle without a stylet, 45.3 per cent were nontraumatic, 35.8 per cent were traumatic and 18.9 per cent unsuccessful. There is no statistically significant difference between these groups. Table I1 shows the results of the 20 pairs of lumbar punctures done on 17 patients. Of the 11 pairs in which the first CSF cell-count was greater than 5000 ~ ~ c / m r n ~ or in which the CSF was described as ‘bloody’, the white blood cell (WBC)count in the second lumbar puncture was less than 10/mm3in eight cases, 15/mm3in one case and 25/mm3 in two instances. The range of intervals between lumbar punctures was 0.5 to 13days, with a mean of six days. In nine pairs in which the initial result was described as ‘clear’ and less than 5000 R B C / were ~ ~ present, ~ the WBC count of the second lumbar puncture was 1l/mm3or less in seven cases, and 33/mm3 and 35/mm3 in one case each.
TABLE I Traumatic and unsuccessfbl lumbar punctures Type of needle
With stylet Butterfly, without stylet 23-gauge, without stylet
No. of punctures
Non-traumatic
Traumatic
Unsuccessful
Traumatic f unsuccessful
177
No. 96
54.2
No. 39
22.0
No. 42
23.7
No. 81
45.7
59
32
54.2
18
30.5
9
15.3
27
45.8
53
24
45.3
19
35.8
10
18.9
29
54.7
%
484
%
%
%
RICHARD L. SCHREINER
MARTIN B. KLEIMAN
TABLE I1 Results of CSF analysis of 20 pairs of lumbar punctures (LP) Birthweight Age EGA* Time LP I WBClmm’ (g) (days) (wks) between description (3rd tube) L Ps (days) LPI LP2
RBClmm) (3rd tube) LPI
LP2
Glucose Protein (mgi1OOml) (mgll00ml)
L P I LP2
LP1 LPZ ~
I 2
2.840 2,700 4.763 1,640 3.000 1.219 3.960 1,810 1.220 3,770 1.276
6 7 9 40 1 7 I2 14
3.000 3.742 822 709 1,276
7 4 25 2 27
41 40 31
10
zn
3.005 3.460 1.920 3.770
II I H 12
1
40 38 42 34 41 28 24 34 31 38 30
7 6 4 2 7
Bloody Bloody Bloody Bloody Bloody Bloody Bloody Bloody Bloody Bloody Bloody
34 50 67 21 52 900 292 1
15
2 0 5
40n
25 2 25 3 2 6 3
52 3 33
35 33 I
18
10
30
13 4
Clear Clear Clear Clear Clear
3
7
41 40 34 38
5 3 I I
Clear Clear Clear Clear
40 3 13 6
1 9
5
4 13 3 0.5 13
4 15
-
1
11
12.300 17 1.600 40.500 127.400 1.685 99.750 72,000 so0 Bloody Bloody 72.000
2,425 I I4 S.365 7.720 83 3,800 671 2.455 0 77 870
1.685 4,150 2.020 2.400 870
70 112 3 0 12.250
414 20 31 77
3 4 143 9
59 44 34 22 24 54 38 54 -
R9 45 44 32 28 69 3S 66 64 69
26
15
290
24 83
30 82 69 61 18
214 73
58
55
I5 70 65
76 69
63 64 32 45
1 04 403 145
-
71 H2 R2 590 122 175
240 79
85 81
-
83 81 321
185
214
-
150
140 327 72 59
88 81
89 31 128 198 210 54 90 90 76
*Estimated gestational age
Discussion Some authors (e.g. Greensher et al. 1971) advocate the use of needles without stylets for lumbar puncture in infancy, claiming that the procedure is simpler to perform and that manometric measurements are more easily determined. However, most neonatal lumbar punctures are for the diagnosis of infection o r intracranial hemorrhage, and manometry is infrequently needed. The present study demonstrates that the incidence of unsuccessful and traumatic punctures is the same whether a needle with a stylet or a butterfly or standard venipuncture needle without stylet is used. In view of the evidence associating epidermoid tumors with the use of needles without stylets, we recommend the use of a stylet needle. Desirable characteristics for a needle for use in the neonatal period would include: (1) length of approximately %-inch; (2) 23 to 25-gauge diameter; (3) short bevel; and (4) semi-transparent hub. Unfortu-
nately, a needle of this design is not yet available. Kolmel (1977) states that intracranial hemorrhage may result in CSF pleocytosis, sometimes as high as 1500 w ~ c / m mand ~, the pleocytosis may last as long as six months after intracranial hemorrhage. The effect of blood introduced into the CSF following traumatic lumbar puncture is not completely understood. Oehmichen (1976) has found large numbers of granulocytes eight to 12 hours after traumatic puncture, He found that the r e l a t i v e n u m b e r of g r a n u l o c y t e s decreased in succeeding hours, and that there was a gradual shift to a predominance of mononuclear cells after three to 20 days. Dyken (1975) studied a group of 28 adult patients with blood contamination as a result of traumatic taps and found an average cell-count in subsequent taps of 117 w ~ d m mof~ which , 2 1? 13 per cent were granulocytes. Three newborns studied had an average of 374 w~clmm’ 485
DEVELOPMENTAL MEDICINE A N D C H I L D NEUROLOGY.
with 30220 per cent granulocytes. However, the interval between the pairs of lumbar punctures was not reported. The amount of blood entering the subarachnoid space during a traumatic puncture is variable, and may sometimes result in a significant and prolonged CSF pleocytosis. Studies in animals are needed to prove whether the quantity of blood contaminating the CSF during traumatic lumbar puncture affects the degree and duration of the CSF white blood-cell resuonse. The present study demonstrates that CSF uleocvtosis is not uresent two to three days afte; traumatic iuncture. Due to the inadequate numbers of patients for whom the time-interval between punctures was less than two days, conclusions cannot be
1979, 21
reached about infants undergoing a second lumbar puncture within two days of a traumatic puncture. It is possible that some of our infants had a very mild subarachnoid hemorrhage rather than a traumatic lumbar puncture, but this would not alter our conclusion significantly, since there was no evidence of a CSF white blood-cell response to the red blood-cells in the CSF. AUTHORS’ APPOINTMENTS
Richard L. Schreiner, M.D., Associate Professor of Pediatrics; Martin B. Kleiman, M.D., Assistant Professor of Neonatal-PerinatalMedicineand Infectious Disease, Department of Pediatrics, Indiana University School of Medicine, and the James Whitcomb Riley Hospital for Children, Indianapolis, Indiana. ~~~~~~~~f
SUMMARY
The incidence of non-traumatic, traumatic and unsuccessful lumbar punctures in 18 1 neonates was similar whether a needle with a stylet, a butterfly needle without stylet, or a standard venipuncture needle without stylet was used. Comparison of 20 lumbar puncture pairs in 17 patients showed that traumatic lumbar puncture does not result in a cerebrospinal fluid pleocytosis between two and 13 days after initial traumatic lumbar puncture. RESUME
FrCquence et effet des ponctions lombaires traumatisantes chet le nouveau-nk La frkquence des ponctions lombaires non traumatisantes, traumatisantes et infructueuses chez 181 nouveaux-nks a CtC identique que I’on ait utilisk une aiguille de Fonction lombaire avec mandrin, une aiguille papillon sans mandrin ou une aiguille de ponction veineuse standard, sans mandrin. La comparaison de 20 ponctions lombaires couplees chez 17 malades a montrC que la ponction lombaire traumatisante ne provoquait pas de pleiocytose du LCR deux tt 13 jours aprks la ponction lombaire initiale traumatisante.
ZUSAMMENFASSUNG
Haufigkeit und Auswirkungen einer traumatischen Lumbalpunktion beim Neugeborenen Bei 181 Neugeborenen wurden Lumbalpunktionen durchgefuhrt und es fand sich, da13 die Haufigkeit einer gelungenen, einer traumatischen oder einer erfolglosen Lumbalpunktion etwa gleich war bei der Verwendung einer Lumbalpunktionsnadel mit Mandrin, einer Butterflynadel ohne Mandrin oder einer gewohnlichen Venenkanule ohne Mandrin. Der Vergleich von 20 Doppelpunktionen bei 17 Patienten zeigte, daS durch eine traumatische Lumbalpunktion zwei bis 13 Tage nach der ersten Punktion keine Pleocytose hervorgerufen wurde. 486
RICHARD L. SCHREINER
MARTIN B. KLEIMAN
RESUMEN
Zncidencia y efecto de la puncidn lumbar traumrftica en el recien nacido La incidencia de punciones lumbares no traumhticas, traumhticas, y sin Cxito en 181 reciCn nacidos fue similar utilizando una aguja de punci6n lumbar con un estilete, una aguja de mariposa sin estilete o una aguja corriente de punci6n venosa sin estilete. La comparaci6n de 20 pares de punci6n lumbar en 17 pacientes mostr6 que la punci6n lumbar traumhtica no producia una pleocitosis en el liquid0 cefaloraquideo entre 10s dos y trece dias despues de la puncibn lumbar inicial traumhtica. REFERENCES Batnitzky, S., Keucher, T. R., Mealey, J., Campbell, R. L. (1977) ‘Iatrogenic intraspinal epidermoid tumors.’ Journal of the American Medical Association, 237, 148. Choremis, C., Economos, D., Papadatos, C., Gargoulas, A. (1 956) ‘Intraspinal epidermoid tumours (cholesteatomas) in patients treated for tuberculous meningitis.’ Lancet, 2, 437-439. Dyken, P. R. (1975) ‘Cerebrospinal fluid cytolo y practical clinical usefulness.’ Neurology, 25, 210-21 7. Greensher, J., Mofenson, H. C., Borofsky, L. 8.,:Sharma, R. (1971) ‘Lumbar puncture in the neonate: a simplified technique.’ Journal of Pediatrics, 7 8 , 1034-1035. Kolmel, H. W. (1977) Atlas of Cerebrospinal Fluid Cells, New York: Springer. Oehmichen, M. (1976) Cerebrospinal Fluid Cyrology, Philadephia: Saunders. Shaywitz, B. A. (1973) ‘Spinal taps and epidermoid tumors.’ Hospital Practice, 8, 79.
487
Incidence and Effect of Traumatic Lumbar Puncture in the Neonate Richard L. Schreiner Martin B . Kleiman
Introduction Lumbar puncture is frequently required to diagnose meningitis or intracranial hemorrhage in the neonate. There is controversy concerning the optimum method for the procedure, as well as the effect of traumatic lumbar puncture on the cerebrospinal fluid (CSF) cell count in subsequent spinal taps. Choremis et af. (1956), Shaywitz (1973) and Batnitzky et af. (1977) have associated the use of a needle without a stylet with the development of spinal epidermoid tumors. Others recommend using needles without stylets for lumbar puncture, claiming that the procedure is easier to perform and less likely to be traumatic (Greensher et af. 1971). It is postulated that blood introduced into the CSF during a traumatic lumbar puncture may result in a pleocytosis in subsequent spinal taps. The purposes of this study were: (1) to determine the incidence of non-traumatic, traumatic and unsuccessful lumbar punctures performed with different types of needles in the neonatal period and (2) to determine the effect of a traumatic puncture on CSF white blood-cell response in subsequent spinal taps.
1977, all lumbar punctures performed in the James Whitcomb Riley Hospital Newborn Intensive Care Unit were prospectively evaluated. Indications for the procedure were determined by the house staff and attending physicians caring for the infants and did not involve the authors of the present study. The following information was collected: patient’s name; birthweight; age; gestational age, estimated by physical examination; indication for lumbar puncture; infant’s diagnosis; result of CSF cellcount, glucose, protein, gram stain and culture; physician performing spinal tap; type of needle used; and a description of the gross appearance of the fluid. Each physician chose the type of needle with which they felt most confident. The CSF cell-count was performed within one hour of the spinal tap, using a standard counting chamber. The CSF white blood-cell differential count was performed by examination of a Wright stained smear, prepared by means of a cell centrifuge (Cytospin, Shandon Southern Instruments, Sewickley, Pennsylvania). Of the 435 patients admitted to the Newborn Intensive Care Unit during the period of study, 199 underwent lumbar puncture. Complete information was available on 181 of these 199 infants, who
Material and Method From 18th January 1977 to 18th July ~
Correspondence to Richard L. Schreiner, M.D., Department of Pediatrics, Indiana University School of Medicine, 1100 West Michigan Street, Indianapolis, Indiana 46223.
483
DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY.
1979, 21
Rutherford, New Jersey).
underwent a total of 246 lumbar punctures. Patients with central nervous system infection were excluded from the study. The age of the infants ranged from 0 to 150 days (mean 7.3 days) at the time of the initial puncture. A lumbar puncture was defined as traumatic when 5000 or more red bloodcells ( R B C ) were / ~ ~ present ~ in the third tube of CSF collected, and there was no clinical evidence (falling hematocrit, seizures, bulging fontanelle) or laboratory evidence (computerized axial tomography) of intracranial hemorrhage. This, of course, would not differentiate a traumatic lumbar puncture from a very mild subarachnoid hemorrhage. The procedure was considered unsuccessful when spinal fluid was not obtained. The study of the effect of traumatic lumbar puncture on the CSF cellular response in subsequent taps was based upon data from patients in whom two punctures were performed within a 15-day period and in whom there was no evidence of central nervous system infection or hemorrhage. There were 17 patients in this category. Needles used to perform lumbar punctures included a 22-gauge, 1%-inch LP needle with a stylet (Pharmaseal Laboratories, Glendale, California), a 23-gauge butterfly infusion needle (Abbott Hospitals, Inc., N. Chicago, Illinois), and a standard 23-gauge, 3/4-inch venipuncture needle (Becton-Dickinson,
Results Of the 177 lumbar punctures attempted with a 22-gauge needle with a stylet, 54.2 per cent were non-traumatic, 22 per cent were traumatic and 23.7 per cent were unsuccessful (Table I). Of the 59 attempts with a 23-gauge butterfly needle without a stylet, 54-2 per cent were non-traumatic, 30.5 per cent were traumatic and 15.3 per cent were unsuccessful. Of the 53 attempts with a standard 23-gauge needle without a stylet, 45.3 per cent were nontraumatic, 35.8 per cent were traumatic and 18.9 per cent unsuccessful. There is no statistically significant difference between these groups. Table I1 shows the results of the 20 pairs of lumbar punctures done on 17 patients. Of the 11 pairs in which the first CSF cell-count was greater than 5000 ~ ~ c / m r n ~ or in which the CSF was described as ‘bloody’, the white blood cell (WBC)count in the second lumbar puncture was less than 10/mm3in eight cases, 15/mm3in one case and 25/mm3 in two instances. The range of intervals between lumbar punctures was 0.5 to 13days, with a mean of six days. In nine pairs in which the initial result was described as ‘clear’ and less than 5000 R B C / were ~ ~ present, ~ the WBC count of the second lumbar puncture was 1l/mm3or less in seven cases, and 33/mm3 and 35/mm3 in one case each.
TABLE I Traumatic and unsuccessfbl lumbar punctures Type of needle
With stylet Butterfly, without stylet 23-gauge, without stylet
No. of punctures
Non-traumatic
Traumatic
Unsuccessful
Traumatic f unsuccessful
177
No. 96
54.2
No. 39
22.0
No. 42
23.7
No. 81
45.7
59
32
54.2
18
30.5
9
15.3
27
45.8
53
24
45.3
19
35.8
10
18.9
29
54.7
%
484
%
%
%
RICHARD L. SCHREINER
MARTIN B. KLEIMAN
TABLE I1 Results of CSF analysis of 20 pairs of lumbar punctures (LP) Birthweight Age EGA* Time LP I WBClmm’ (g) (days) (wks) between description (3rd tube) L Ps (days) LPI LP2
RBClmm) (3rd tube) LPI
LP2
Glucose Protein (mgi1OOml) (mgll00ml)
L P I LP2
LP1 LPZ ~
I 2
2.840 2,700 4.763 1,640 3.000 1.219 3.960 1,810 1.220 3,770 1.276
6 7 9 40 1 7 I2 14
3.000 3.742 822 709 1,276
7 4 25 2 27
41 40 31
10
zn
3.005 3.460 1.920 3.770
II I H 12
1
40 38 42 34 41 28 24 34 31 38 30
7 6 4 2 7
Bloody Bloody Bloody Bloody Bloody Bloody Bloody Bloody Bloody Bloody Bloody
34 50 67 21 52 900 292 1
15
2 0 5
40n
25 2 25 3 2 6 3
52 3 33
35 33 I
18
10
30
13 4
Clear Clear Clear Clear Clear
3
7
41 40 34 38
5 3 I I
Clear Clear Clear Clear
40 3 13 6
1 9
5
4 13 3 0.5 13
4 15
-
1
11
12.300 17 1.600 40.500 127.400 1.685 99.750 72,000 so0 Bloody Bloody 72.000
2,425 I I4 S.365 7.720 83 3,800 671 2.455 0 77 870
1.685 4,150 2.020 2.400 870
70 112 3 0 12.250
414 20 31 77
3 4 143 9
59 44 34 22 24 54 38 54 -
R9 45 44 32 28 69 3S 66 64 69
26
15
290
24 83
30 82 69 61 18
214 73
58
55
I5 70 65
76 69
63 64 32 45
1 04 403 145
-
71 H2 R2 590 122 175
240 79
85 81
-
83 81 321
185
214
-
150
140 327 72 59
88 81
89 31 128 198 210 54 90 90 76
*Estimated gestational age
Discussion Some authors (e.g. Greensher et al. 1971) advocate the use of needles without stylets for lumbar puncture in infancy, claiming that the procedure is simpler to perform and that manometric measurements are more easily determined. However, most neonatal lumbar punctures are for the diagnosis of infection o r intracranial hemorrhage, and manometry is infrequently needed. The present study demonstrates that the incidence of unsuccessful and traumatic punctures is the same whether a needle with a stylet or a butterfly or standard venipuncture needle without stylet is used. In view of the evidence associating epidermoid tumors with the use of needles without stylets, we recommend the use of a stylet needle. Desirable characteristics for a needle for use in the neonatal period would include: (1) length of approximately %-inch; (2) 23 to 25-gauge diameter; (3) short bevel; and (4) semi-transparent hub. Unfortu-
nately, a needle of this design is not yet available. Kolmel (1977) states that intracranial hemorrhage may result in CSF pleocytosis, sometimes as high as 1500 w ~ c / m mand ~, the pleocytosis may last as long as six months after intracranial hemorrhage. The effect of blood introduced into the CSF following traumatic lumbar puncture is not completely understood. Oehmichen (1976) has found large numbers of granulocytes eight to 12 hours after traumatic puncture, He found that the r e l a t i v e n u m b e r of g r a n u l o c y t e s decreased in succeeding hours, and that there was a gradual shift to a predominance of mononuclear cells after three to 20 days. Dyken (1975) studied a group of 28 adult patients with blood contamination as a result of traumatic taps and found an average cell-count in subsequent taps of 117 w ~ d m mof~ which , 2 1? 13 per cent were granulocytes. Three newborns studied had an average of 374 w~clmm’ 485
DEVELOPMENTAL MEDICINE A N D C H I L D NEUROLOGY.
with 30220 per cent granulocytes. However, the interval between the pairs of lumbar punctures was not reported. The amount of blood entering the subarachnoid space during a traumatic puncture is variable, and may sometimes result in a significant and prolonged CSF pleocytosis. Studies in animals are needed to prove whether the quantity of blood contaminating the CSF during traumatic lumbar puncture affects the degree and duration of the CSF white blood-cell resuonse. The present study demonstrates that CSF uleocvtosis is not uresent two to three days afte; traumatic iuncture. Due to the inadequate numbers of patients for whom the time-interval between punctures was less than two days, conclusions cannot be
1979, 21
reached about infants undergoing a second lumbar puncture within two days of a traumatic puncture. It is possible that some of our infants had a very mild subarachnoid hemorrhage rather than a traumatic lumbar puncture, but this would not alter our conclusion significantly, since there was no evidence of a CSF white blood-cell response to the red blood-cells in the CSF. AUTHORS’ APPOINTMENTS
Richard L. Schreiner, M.D., Associate Professor of Pediatrics; Martin B. Kleiman, M.D., Assistant Professor of Neonatal-PerinatalMedicineand Infectious Disease, Department of Pediatrics, Indiana University School of Medicine, and the James Whitcomb Riley Hospital for Children, Indianapolis, Indiana. ~~~~~~~~f
SUMMARY
The incidence of non-traumatic, traumatic and unsuccessful lumbar punctures in 18 1 neonates was similar whether a needle with a stylet, a butterfly needle without stylet, or a standard venipuncture needle without stylet was used. Comparison of 20 lumbar puncture pairs in 17 patients showed that traumatic lumbar puncture does not result in a cerebrospinal fluid pleocytosis between two and 13 days after initial traumatic lumbar puncture. RESUME
FrCquence et effet des ponctions lombaires traumatisantes chet le nouveau-nk La frkquence des ponctions lombaires non traumatisantes, traumatisantes et infructueuses chez 181 nouveaux-nks a CtC identique que I’on ait utilisk une aiguille de Fonction lombaire avec mandrin, une aiguille papillon sans mandrin ou une aiguille de ponction veineuse standard, sans mandrin. La comparaison de 20 ponctions lombaires couplees chez 17 malades a montrC que la ponction lombaire traumatisante ne provoquait pas de pleiocytose du LCR deux tt 13 jours aprks la ponction lombaire initiale traumatisante.
ZUSAMMENFASSUNG
Haufigkeit und Auswirkungen einer traumatischen Lumbalpunktion beim Neugeborenen Bei 181 Neugeborenen wurden Lumbalpunktionen durchgefuhrt und es fand sich, da13 die Haufigkeit einer gelungenen, einer traumatischen oder einer erfolglosen Lumbalpunktion etwa gleich war bei der Verwendung einer Lumbalpunktionsnadel mit Mandrin, einer Butterflynadel ohne Mandrin oder einer gewohnlichen Venenkanule ohne Mandrin. Der Vergleich von 20 Doppelpunktionen bei 17 Patienten zeigte, daS durch eine traumatische Lumbalpunktion zwei bis 13 Tage nach der ersten Punktion keine Pleocytose hervorgerufen wurde. 486
RICHARD L. SCHREINER
MARTIN B. KLEIMAN
RESUMEN
Zncidencia y efecto de la puncidn lumbar traumrftica en el recien nacido La incidencia de punciones lumbares no traumhticas, traumhticas, y sin Cxito en 181 reciCn nacidos fue similar utilizando una aguja de punci6n lumbar con un estilete, una aguja de mariposa sin estilete o una aguja corriente de punci6n venosa sin estilete. La comparaci6n de 20 pares de punci6n lumbar en 17 pacientes mostr6 que la punci6n lumbar traumhtica no producia una pleocitosis en el liquid0 cefaloraquideo entre 10s dos y trece dias despues de la puncibn lumbar inicial traumhtica. REFERENCES Batnitzky, S., Keucher, T. R., Mealey, J., Campbell, R. L. (1977) ‘Iatrogenic intraspinal epidermoid tumors.’ Journal of the American Medical Association, 237, 148. Choremis, C., Economos, D., Papadatos, C., Gargoulas, A. (1 956) ‘Intraspinal epidermoid tumours (cholesteatomas) in patients treated for tuberculous meningitis.’ Lancet, 2, 437-439. Dyken, P. R. (1975) ‘Cerebrospinal fluid cytolo y practical clinical usefulness.’ Neurology, 25, 210-21 7. Greensher, J., Mofenson, H. C., Borofsky, L. 8.,:Sharma, R. (1971) ‘Lumbar puncture in the neonate: a simplified technique.’ Journal of Pediatrics, 7 8 , 1034-1035. Kolmel, H. W. (1977) Atlas of Cerebrospinal Fluid Cells, New York: Springer. Oehmichen, M. (1976) Cerebrospinal Fluid Cyrology, Philadephia: Saunders. Shaywitz, B. A. (1973) ‘Spinal taps and epidermoid tumors.’ Hospital Practice, 8, 79.
487
