<aside> 💡 TLDR

• sterile procedure

• Position: lying lateral or sitting, max spinal flexion

• Prep: betadine/chlorhex, topical/local/oral analgesia as appropriate (lignocaine, sucrose, EMLA/AnGEL)

• equipment: 22-25 gauge needle with stylet

• Procedure

  • Aim in the midline, L3-4 or L4-5 interspace (line between iliac crests)
  • Bevel aiming to side of pt
  • Angle needle aiming for umbilicus
  • Advance into spinous ligament, (increased resistance)
  • Advance slowly until fall in resistance (may not be obvious in neonates)
  • remove stylet
  • catch 5-10 drops per tube, 3 tubes (PCR, biochem, MCS)
  • replace stylet and put pressure/dressing </aside>

• Indications

• Contraindications

• Complications

• Equipment

• Analgesia

• Position

• Preparation

• Lumbar puncture

• Post procedure care

Interpretation

• If abnormal, the safest course is to treat for bacterial meningitis
• If high clinical suspicion of meningitis but normal CSF, still be treated with IV antibiotics, pending cultures.
• ANY neutrophils in CSF is unusual in normal children - raises concern about bacterial meningitis
• white cell count and protein level higher at birth, fall rapidly in the first 2 weeks of life.
• Consider SAH when unexplained or persistent RBCs in CSF
• Delays in lab analysis can alter cell count due to lysis. Progressive reduction in neutrophils and lymphocytes after 4 hours