Bedside Ultrasound Assisted Pediatric Lumbar Puncture

This is a prospective, randomized study evaluating the efficacy of bedside ultrasound assisted lumbar puncture in pediatric patients

Comparison of bedside ultrasound assisted lumbar puncture to traditional anatomical landmark approach in neonates and young infants requiring lumbar puncture

Sonosite M-Turbo ultrasound device (Bothell, WA) with a L25 linear transducer, or, Zonare Z.One device(Mountain View, CA) with a L10-5 linear array transducer,

An investigator will perform beside ultrasound on the spinal area using a bedside ultrasound device. Attempts will be made to visualize the spinous processes and vertebral bodies in the general lumbarsacral area, as well as the presence of CSF in the thecal space below the conus medullaris, and identify the optimal location to perform the LP. This will be marked with a skin marker (If no CSF or abnormal anatomy is visualized, the LP will be advised to be postponed or cancelled). The treating physician will then proceed with the LP guided by the skin markings.

failure to yield enough fluid for cerebrospinal fluid cell count as indicated by operator report on data collection sheet

whether there was any adverse effect/ complication due to lumbar puncture based on review of medical record

Inclusion Criteria: Any patient 0-12 months old requiring a lumbar puncture in the pediatric emergency department or inpatient pediatric floor is eligible to participate in the study Exclusion Criteria: previous back surgeries parent/ guardian inability to understand informed consent parent/guardian refusal of informed consent.