Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. The Cochrane Neonatal Group produces and updates Cochrane Reviews to provide comprehensive coverage of the evidence on the care of babies and infants. In this podcast, we present an important topic in neonatal care: the management of pain and discomfort during spinal taps in newborns, for which a new Cochrane review was published in September 2023. In this podcast, two of the authors talk about the findings. Ehsan Hedayati and Sara Pessano, welcome to the podcast.

Ehsan: Thank you, Mike. Sara, let's start with a brief description of a spinal tap and why it's performed, especially in newborns.

Sara: Sure. A spinal tap, also known as a lumbar puncture, is a common procedure for people of any age. It involves inserting a hollow needle into the spine to extract cerebrospinal fluid, which is the fluid that surrounds the brain and spinal cord. In newborns, spinal taps may be used to check for infections that could affect the brain or spine, but it can cause significant pain and discomfort.

Ehsan: Yes, and of course we want to avoid pain and discomfort, not least because if the infant is uncomfortable, it might take several attempts to complete the spinal tap. Spinal taps can also lead to complications in newborns, such as a slowing of the heartbeat, called bradycardia, and apnea, which is an interruption in breathing. These complications can also cause desaturation, a reduction in the oxygen content of the blood. So, Sara, please describe what we aimed to study in our review.

Sara: We wanted to determine whether certain medicines were more effective than others, or than no medicine at all, in reducing pain and discomfort during a spinal tap in newborns. Specifically, we looked at whether these medicines could decrease the number of attempts needed for a successful spinal tap, reduce episodes of bradycardia and desaturation, and prevent apnea. Ehsan, would you like to continue with what we found?

Ehsan: We reviewed three studies involving 206 newborns. The studies examined topical anesthetics, which are painkillers applied directly to the skin, compared to no medicine. However, the evidence was unclear about whether these topical anesthetics improved the outcomes that you mentioned, but we did find that topical anesthetics might reduce pain during the procedure by 15% to 20%.

Sara: We should also say something about the limitations in this current evidence. In addition to the problem that so few studies were available, we have little confidence in those findings for pain because the studies used different measures to assess it. Moreover, in some cases, participants might have known which treatment was being used, which could influence the results. Lastly, not all studies provided data on all the outcomes we were interested in.

Ehsan: With those limitations in mind, it’s worth noting that we know of three large studies assessing other medicines for newborns having a spinal tap, which aren't published yet. There are also another three studies that we’re still looking into to see if they should be included in the review. This means that at least some of the many unanswered questions might be answered by these additional studies.

Sara: Thanks Ehsan. To finish, if listeners want to learn more about this topic, the review is available online at www dot Cochrane library dot com. If they search for "spinal tap pain management in newborns", they’ll find it.