Lumbar Puncture in neonates

[DrMetal]

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Hello, question about LPs in infants/neonates:

I was reading an UptoDate article and found a nice algorithm, 'Management Algorithm for Infants (> 1 month) and children with suspected bacterial meningitis' (I wont post the graphic here per copyright issues, but I'm sure you've seen something similar).

The algorithm states, basically, to watch out for intracranial processes . . .that if you suspect one, LP should be deferred until after a CT Head for further evaluation. That makes sense.

My question is: how would this algorithm differ for a < 1 month old, with respect to getting a CT before the LP? In other words, if a 2-weeker presents with a high fever, poor eating, sleep, etc . . . and happens to have a bulging fontanelle, do you CT before getting the LP? Or just go straight to LP? [I was reading somewhere that you go straight to LP, even in the setting of bulging fontanelle, because a herniation is very unlikely to happen in a child this young (< 1 month) . . . is this true?]

Thanks!

 

[Stitch]

In a febrile neonate I rarely CT prior to LP unless something just doesn't look right. An exception might be if I see bruising or suspect abuse, but the scenario you describe suggests infection and not a whole lot else.

 

[DrMetal]

In a febrile neonate I rarely CT prior to LP unless something just doesn't look right. An exception might be if I see bruising or suspect abuse, but the scenario you describe suggests infection and not a whole lot else.

Ok thank you!

 

[g12321]

How about an LP for patients having a fever lasting more than 3 days and temp constantly above 38.5?

 

[Stitch]

How about an LP for patients having a fever lasting more than 3 days and temp constantly above 38.5?

What age group? I'd tap a neonate for a single temp above 38.3 until 5 weeks or so. Beyond that, it really depends on the patient and what they look like. I'd even take vaccinations into account in the very young (say 3 months).