Understanding infant spinal taps
Frequently asked questions
What is a lumbar puncture?*
A lumbar puncture is a test where a doctor uses a needle to get fluid from your baby’s lower back. This fluid is called cerebrospinal fluid, or CSF. Your baby is placed on their side and is held still, and a doctor puts a needle between the vertebrae of the lower back. It does not go near the spinal cord. Lumbar punctures are also sometimes called a spinal tap or LP.
Why does my child need a lumbar puncture?*
A lumbar puncture is needed to test the fluid around the brain and spinal cord. This test may be done to find out if a baby has meningitis (a serious infection around the brain). Meningitis may be suspected in a baby with a fever, especially in babies less than one month old. Early diagnosis of meningitis can greatly improve your child's chances of a full recovery. If your child has meningitis, they will need other tests and treatment in hospital.
Lumbar punctures are also done for other reasons, but your child's doctor will discuss these with you before performing an LP.
What to expect?*
Historically, during a lumbar puncture, your baby will be curled in a ball to get a better position. Young children and babies will be held in position by an assistant. A doctor then puts a needle into the spaces between the spine bones to the area where the fluid is. This area is called the subarachnoid space.
Who performs the test?
This test is performed by a doctor in the office or in the hospital.
Medicines that help reduce your child's pain?
Sucrose solution is a special preparation of sugar mixed with sterile water and preservatives. It can provide short-term comfort and pain relief during procedures for infants up to 18 months of age. It has an instant calming effect on infants and triggers the body to release its own pain-relieving responses.
Sucrose solution is given by mouth (on the sides of the mouth or on/under the tongue). It is sometimes given with a pacifier, which can be particularly helpful because sucking also provides comfort to young children. The solution is given two minutes before the start of the procedure, and further small amounts may be given throughout the procedure.
What are the risks?*
A lumbar puncture is a safe test. Sometimes doctors are not able to get fluid, and they may have to try more than once. A small number of children may have a headache or backache for a day or two after the test. The risk of any serious complications, including bleeding, infection, or damage to nerves, is extremely low. When your child is having any kind of procedure, it's understandable to be a little uneasy. But it helps to know that spinal taps are quick, common tests and that complications are rare. If you have any questions or concerns, talk with your doctor.
What does a lumbar puncture show?
Many conditions can be detected in the CSF including:
Infection of the membranes surrounding the brain and spinal cord (meningitis)
Bleeding (subarachnoid hemorrhage, stroke)
Viral infection (encephalitis)
Tumors (lymphoma, cancer)
Autoimmune disorders like multiple sclerosis
What happens if the procedure fails?
1. No CSF obtained
Consult a more experienced practitioner.
Attempt procedure using the next higher intervertebral space.
Failure to obtain CSF should not delay antibiotic treatment in a septic neonate cell counts and PCR obtained after antibiotics are still meaningful.
2. Blood-stained CSF obtained
Possible traumatic bleeding - blood staining tends to clear as the CSF flows
Possible subarachnoid space bleeding
Specimen is still useful for culture, but repeat procedure may be required (usually 24-48 hours later)
If subarachnoid bleeding is strongly suspected, proceed to cranial ultrasound or other imaging
What is the care at home after the procedure?*
After the procedure, your child can be bathed normally. If there is a dressing or sticking plaster (e.g. BandAid) on your child's back, it can be taken off the next day or left to fall off by itself if your child prefers.
Key points to remember:
In a lumbar puncture, a doctor uses a needle to take fluid from your baby’s lower back.
It is the only way to be sure if your baby has meningitis or not and is also used for other tests.
A lumbar puncture is a safe test. The needle does not go near the spinal cord.
* Sourced from the Royal Children's Hospital Melbourne
FROM A DOCTORS PERSPECTIVE
“I can’t believe something this needed hasn’t been developed until now. I anticipate a lot of pent up interest…I have waited all my career for a device to make this procedure easier and I bet many others have as well.”
James J. O'Callaghan, MD
Hospitalist - Pediatrics