Background 
Lumbar puncture (LP) remains the only diagnostic test for neonatal meningitis and relies on a clear sample of cerebro-spinal fluid (CSF) for interpretation. An estimated up to 30,000 neonatal LPs are performed in the UK annually. Reported success rates are only 50-60%. Various modifications to the original technique have been described in the hope of improving success.
Aim: To learn about current practices and establish the prevalence of modifications to the original LP technique within UK neonatal units. 
Methods
An anonymised ‘snapshot’ survey of neonatal LP practice was distributed to paediatric consultants, junior paediatric doctors and advanced neonatal nurse practitioners via social media; regarding needle choice, stylet removal timing, positioning and analgesia.   
Results
This survey received 276 responses over 2 weeks.
LP position: 97% perform neonatal LPs in the lying position. 
Stylet use: 93% use a needle with stylet; of these 89% remove the stylet once they expect the needle is in the CSF space and 10% remove the stylet before advancing the needle into the CSF space. 
Analgesia: Sucrose (94.9%), non-nutritive sucking (59.9%) and milk (23.4%) are the most popular analgesics. 9.5% use numbing cream.
Conclusions
Aside from the addition of stylets, the original LP technique has seen few modifications. The most common UK practice of lying LPs has little supportive evidence. Some observational case-series suggest increased interspinous distance in sitting position and increased success with early stylet removal. Future research should investigate these modifications, and optimising analgesia. Well-powered randomised controlled trials are likely to be needed to change current practice.

NEONATAL LUMBAR PUNCTURES: PAST, PRESENT AND FUTURE - A SURVEY OF CURRENT UK PRACTICE