172 - Evaluation of a curriculum for ultrasound-assisted lumbar puncture in the Neonatal Intensive Care Unit

Publication Number: 4169.172

Leah Downey, Oregon Health & Science University, Portland, OR, United States; Catherine G. Caruso, Doernbecher Children's Hospital at Oregon Health & Science University, PORTLAND, OR, United States; Dmitry Dukhovny, Oregon Health and Science University, Portland, OR, United States; Andrew J. Giustini, Doernbecher Children's Hospital at Oregon Health & Science University, Portland, OR, United States

Background: Lumbar puncture (LP) in neonates is technically challenging, with high rates of failure and traumatic taps. Point-of-care ultrasound (POCUS) can improve landmark identification and procedural success, yet formal training within Neonatology is limited. Developing a structured POCUS curriculum for ultrasound-assisted LP represents an opportunity to address a key procedural skill gap and to introduce sustainable ultrasound education in the Neonatal Intensive Care Unit (NICU).

Objective: To evaluate the feasibility and impact of a structured POCUS curriculum on provider knowledge and confidence using ultrasound for neonatal LP.

Design/Methods: We conducted a single-center, prospective observational study in a 46-bed Level IV academic NICU. Eight neonatal providers, including fellows, advanced practice providers, attendings, and hospitalists, participated in a standardized one-hour training session combining didactic instruction and hands-on ultrasound scanning using stable patients with parental consent. Knowledge and self-reported comfort were assessed by structured surveys administered pre-training, and at 1-, 3-, 6-, and 12-months post-intervention. Knowledge was measured by identification of spinal anatomy and probe selection, comfort was assessed using 5-point Likert scales. Wilcoxon signed-rank tests evaluated paired pre-post changes, with significance set at p < 0.05.

Results: Seven participants completed both pre- and post-training assessments. Median comfort improved from 2.0 (IQR 1.0-2.0) to 4.0 (IQR 4.0-4.0) immediately post-training (p = 0.016, r = 0.89), with sustained scores ≥ 4 through 12 months. Knowledge scores increased from 8/10 (IQR 7-9) to 9/10 (IQR 9-9) (p=0.026). Participants reported applying POCUS skills in clinical care, and institutional use of ultrasound for LP increased following the intervention based on self-report on follow-up surveys.

Conclusion(s): A brief, structured POCUS curriculum focused on ultrasound-assisted LP was feasible for multidisciplinary NICU providers and produced sustained improvements in knowledge and procedural confidence. These findings highlight the educational value of targeted POCUS training within neonatal curricula and support further evaluation of its impact on procedural performance and patient outcomes.

Figure 1: Immediate change in self-reported comfort with ultrasound-assisted lumbar puncture.
Comfort scores were measured using a 5-point Likert scale (1 = very uncomfortable, 5 = very comfortable). Among 7 participants with paired responses, scores increased significantly from a median of 2.0 (IQR 1.0-2) pre-training to 4.0 (IQR 4.0-4.0) post-training (Wilcoxon signed-rank test, p = 0.016, r = 0.89). Boxplots display median (bold line), interquartile range (box), and data range excluding outliers (whiskers). The post-training score of 5 is plotted as an outlier per standard 1.5xIQR criteria.

Figure 2: Immediate change in knowledge scores following training.
Participants (n = 7) completed a 10-item knowledge quiz before and immediately after the training. Median scores increased from 8.0 (IQR 7-9) to 9.0 (IQR 9-9), with a mean improvement of 1.4 ± 1.1 points (Wilcoxon signed-rank test, p = 0.026). Five of seven participants improved, while two maintained high baseline scores. Boxplots display median (bold line), interquartile range (box), and data range excluding outliers (whiskers). The post-training score of 7 is plotted as an outlier per standard 1.5xIQR criteria.