Chapter 8 - When to Perform Lumbar Puncture in Infants at Risk for Meningitis in the Neonatal Intensive Care Unit

Abstract

Meningitis occurs most commonly in the neonatal period and is associated with significant morbidity and mortality. Examination of the cerebrospinal fluid is essential for diagnosis, identification of pathogens, and appropriate choice of therapy. However, the role of lumbar puncture in the diagnostic evaluation of neonatal sepsis remains controversial. Clinicians caring for infants in the neonatal intensive care unit often choose to defer lumbar puncture due to low suspicion for meningitis or due to presumed risk of the procedure. However, a significant proportion of infants with meningitis have negative blood cultures. Selective evaluation of infants with culture-proven bacteremia can also result in missed diagnoses of meningitis. In this chapter, we provide evidence-based recommendations for when lumbar puncture should be performed in infants at risk for meningitis in the neonatal intensive care unit.