title: Epidural catheter placement in neonates: sonoanatomy and feasibility of ultrasonographic guidance in term and preterm neonates.
abstract: BACKGROUND
  We report the first prospective sonoanatomic study in neonates with the aim to perform ultrasonographic-guided epidural catheter placement in this age group.
  
  
  METHODS
  One hundred forty-five neonates with a body weight < or =4 kg (0.53-4 kg) were included in this prospective study. The study was divided into 3 consecutive parts. In the first part, the neuraxial sonoanatomy of 60 neonates was evaluated. In the second part, 50 neonates scheduled for major abdominal surgery were enrolled. In this part, the depth of the ligamentum flavum measured with ultrasound was matched up to the depth evaluated clinically with the loss-of-resistance technique. In the third part, ultrasonographic epidural catheter placement was performed in 35 neonates weighing between 620 g and 4 kg.
  
  
  RESULTS
  The ligamentum flavum, the dura mater, and the termination of the spinal cord could be identified in all patients. The first part showed a good correlation between body weight and depth of the ligamentum flavum. The median termination of the spinal cord corresponded to vertebral level L2. The second part confirmed a good correlation between depth of the ligamentum flavum evaluated clinically and the depth predicted with ultrasound. Finally, real-time ultrasound-guided epidural placement was possible in all 35 neonates.
  
  
  CONCLUSIONS
  Ultrasound examination of the spinal cord anatomy provides valuable information for epidural catheter placement in neonates. Ultrasonography enables a real-time identification of the tip of the needle within the epidural space and a visualization of the spread of local anesthetic in these patients.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria. harald.willschke@meduniwien.ac.at
authors.forename: Harald
authors.initials: H
authors.lastname: Willschke
authors.forename: Adrian
authors.initials: A
authors.lastname: Bosenberg
authors.forename: Peter
authors.initials: P
authors.lastname: Marhofer
authors.forename: Julie
authors.initials: J
authors.lastname: Willschke
authors.forename: Jens
authors.initials: J
authors.lastname: Schwindt
authors.forename: Marion
authors.initials: M
authors.lastname: Weintraud
authors.forename: Stephan
authors.initials: S
authors.lastname: Kapral
authors.forename: Stephan
authors.initials: S
authors.lastname: Kettner
mesh_terms: D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000493:pharmacokinetics; D002404:Catheterization / Q000379:methods*; D004824:Epidural Space / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D011446:Prospective Studies; D013116:Spinal Cord / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D000779:Anesthetics, Local