Should We Be Drawing on Babies Before Tapping Them?

Lumbar puncture (LP) is commonly performed in infants to rule out meningitis but is often not successful in the hands of inexperienced operators. Investigators at an academic pediatric emergency department randomized 128 infants younger than 6 months to traditional LP or LP preceded by ultrasound-guided skin marking of anatomic landmarks.

Ultrasound-guided marking was performed by one of three operators: a board-certified pediatric emergency physician with advanced ultrasound training, a senior resident, or a medical student. The resident and student completed an introductory ultrasound course and identified the landmarks successfully on at least five practice cases.

In the study, 54% of LPs were performed by operators with little or no LP ex…