RT Book, Section
A1 Gomella, Tricia Lacy
A1 Eyal, Fabien G.
A1 Bany-Mohammed, Fayez
SR Print(0)
ID 1168356442
T1 Lumbar Puncture (Spinal Tap)
T2 Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, 8e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781259644818
LK accesspediatrics.mhmedical.com/content.aspx?aid=1168356442
RD 2024/04/23
AB Obtain  cerebrospinal  fluid  for  the  diagnosis  of  central  nervous  system  disorders  such  as  meningitis/encephalitis.Infections  that  can  be  diagnosed  are  bacterial,  viral,  fungal,  and  TORCH  (toxoplasmosis,  other  [usually  syphilis],  rubella,  cytomegalovirus,  and  herpes  simplex  virus).  Meningitis  can  be  present  in  as  many  as  23%  of  cases  of  neonatal  sepsis,  and  blood  cultures  can  be  negative  in  up  to  38%  of  infants  with  meningitis.Initial  sepsis  workup  (controversial).  If  central  nervous  system  (CNS)  involvement  is  suspected  or  blood  cultures  are  positive,  some  sources  recommend  a  lumbar  puncture  (LP).  Because  signs  and  symptoms  of  neonatal  meningitis  are  vague  and  nonspecific,  some  clinicians  advise  that  all  infants  with  proven  or  suspected  sepsis  undergo  LP.  The  American  Academy  of  Pediatrics  (AAP)  recommends  that  an  LP  be  performed  in  any  infant  with  a  positive  blood  culture,  when  clinical  course  or  laboratory  findings  highly  suggest  sepsis,  or  in  an  infant  with  worsening  clinical  status  on  antibiotic  therapy.  Delay  the  LP  in  any  infant  who  is  critically  ill  who  will  not  be  able  to  tolerate  the  procedure.  (Confirm  that  the  antibiotic  dosage  will  cover  for  meningitis.)Diagnose  an  inborn  error  of  metabolism.  Multiple  cerebrospinal  fluid  (CSF)  studies  exist  that  can  help  delineate  different  inborn  errors  of  metabolism,  including  but  not  limited  to  amino  acid  analysis  for  nonketotic  hyperglycinemia  and  CSF  lactate-to-pyruvate  ratio  for  mitochondrial  disorders.Drainage  of  cerebrospinal  fluid  in  communicating  hydrocephalus  associated  with  intraventricular  hemorrhage.  (Serial  LPs  for  this  are  controversial.)  A  Cochrane  review  (2017)  found  the  following:  “There  was  no  evidence  that  repeated  removal  of  CSF  via  LP,  ventricular  puncture  or  from  a  ventricular  reservoir  produces  any  benefit  over  conservative  management  in  neonates  with  or  at  risk  for  developing  post  hemorrhagic  hydrocephalus  in  terms  of  reduction  of  disability,  death  or  need  for  placement  of  a  permanent  shunt.”Aid  in  the  diagnosis  of  intracranial  hemorrhage.  CSF  studies  are  indicative  but  not  diagnostic  for  intracranial  hemorrhage.  Signs  include  a  large  number  of  red  blood  cells  (RBCs),  xanthochromia,  increased  protein  content,  and  hypoglycorrhachia  (abnormally  low  CSF  glucose).Administration  of  intrathecal  medications.  Chemotherapy,  antibiotics,  anesthetic  agents,  or  contrast  material.Evaluation  of  antibiotic  efficacy  in  CNS  infections  by  examining  CSF  fluid.Diagnose  CNS  involvement  with  leukemia.