October 1992

Uses and Technique of Pediatric Lumbar Puncture

Author Affiliations

From the Department of Radiology, University of New Mexico School of Medicine, Albuquerque (Dr Ward), and the Departments of Family Practice (Dr Ward) and Pediatrics (Dr Gushurst), Kalamazoo Center for Medical Studies, Michigan State University, Kalamazoo.

Am J Dis Child. 1992;146(10):1160-1165. doi:10.1001/archpedi.1992.02160220046019

• Objectives.  —To review diagnostic and therapeutic indications, contraindications, complications, and technique of pediatric lumbar puncture with emphasis on diagnosis of bacterial meningitis in bacteremia, cellulitis, and fever with seizures and to discuss cerebrospinal fluid findings in partially treated infection and traumatic blood-contaminated spinal tap.

Research Design.  —Literature review.

Conclusions.  —We recommend lumbar puncture for children younger than 1 year with bacteremia, children with Haemophilus influenzae type B cellulitis, and children with fever and seizures not classified as simple. Pretreatment with antibiotics rarely changes cerebrospinal fluid characteristics such that a diagnosis of bacterial meningitis would be obscured. In a traumatic spinal tap, the equation to predict cerebrospinal fluid pleocytosis based on the peripheral blood cell count is invalid. When used together, cerebrospinal fluid glucose level, Gram's staining, and observed-to-expected ratio of white blood cells are highly reliable in diagnosing bacterial meningitis.(AJDC. 1992;146:1160-1165)