The Role of POCUS in Neonatal Lumbar Puncture

Neonatal lumbar puncture (LP) is an indispensable procedure for diagnosing central nervous system infections. Although nonspecific signs of sepsis present diagnostic challenges, LP remains a cornerstone in evaluating suspected early-onset sepsis. The traditional palpation-guided approach can result in substantial variability and adverse patient complications. Point-of-care ultrasound (POCUS) is emerging as an accessible technology to enhance the traditional palpation-guided LP process by providing real-time visual guidance for needle placement. This quality improvement (QI) project integrated POCUS to refine LP techniques in two Salt Lake City NICUs. Local Problem: In neonatal intensive care, executing LPs is paramount for diagnosing severe infections. The traditional palpation-guided approach can result in substantial variability and adverse patient complications, prompting an innovative approach integrating POCUS to refine the process. Methods: A mixed-methods approach assessed POCUS's integration into the LP process. Training sessions and a newly developed CPG were conducted for neonatal care providers, emphasizing hands-on POCUS techniques to assist in the LP process. Pre- and post-system Usability Scale (SUS) surveys gauged the providers' perceived usability, acceptance, and confidence in using the system. The qualitative data collection assessed the training program's effectiveness and pinpointed barriers during the POCUS integration into routine care. The thematic analysis of open-ended survey responses yielded codes representing common themes. Interventions: The intervention consisted of a comprehensive, standardized POCUS training program and CPG. Education, curated by ultrasound experts, provided participants with practical skills to use ultrasound guidance during the LP process. Results: This study evaluated the POCUS training program's efficacy in improving neonatal care providers' proficiency and confidence from two NICUs in Salt Lake City, Utah. Quantitative analysis of System Usability Scale (SUS) surveys indicated an increase in scores post-training, from an average of 65 to 79 (T-statistic: -3.75, P-value: 0.0057). Overarching categories informed the derivation of codes from participants' qualitative feedback, emphasizing essential improvements and the training program's success. Conclusion: The integration of POCUS into neonatal LP protocols yielded a positive shift in provider perceptions. The findings highlight POCUS's potential as a transformative tool, with future research needed to explore its long-term impacts on patient outcomes and broader clinical applications. This project demonstrates POCUS technology's feasibility in enhancing NICU practices, advocating its expansion as a standard component of neonatal care to improve patient outcomes.