Background: Neonatal and pediatric vascular puncture is critical, with success rates influencing outcomes. While ultrasound is recommended, the efficacy of Dynamic Needle Tip Positioning (DNTP) remains unclear. This review synthesizes evidence on DNTP compared to traditional methods. Objective: To systematically review and meta-analyze DNTP efficacy versus conventional methods (palpation and static ultrasound) in children under 5, focusing on first-attempt success, overall success, duration, and complications. Information Sources: PubMed, Embase, Web of Science, Scopus, Cochrane Library , WanFang, and CNKI were searched from inception to January 2026. Methods: Following PRISMA guidelines, two reviewers screened studies and extracted data. Analyses used random-effects models, with subgroup and sensitivity analyses exploring robustness and moderators like age and operator specialty . Results: Sixteen studies (1,374 patients) were included. DNTP significantly improved firstattempt success (RR = 0.36), reduced duration, and decreased complications, with benefits more pronounced in neonates. Non-anesthesiologists showed robust improvements, suggesting training facilitates dissemination. Overall success improvements were modest. Conclusions: DNTP enhances first-attempt success and reduces complications, especially in neonates. Impact on overall success is limited. Evidence from sedated settings limits generalizability; standardization and multi-center studies in diverse environments are needed.