Uses and technique of pediatric lumbar puncture
E. Ward and C. A. Gushurst
Department of Radiology, University of New Mexico School of Medicine, Albuquerque.
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.