Lumbar puncture in the neonate: challenges in decision making and interpretation

Semin Perinatol. 2012 Dec;36(6):445-53. doi: 10.1053/j.semperi.2012.06.007.


Multiple studies have provided normative ranges for cerebrospinal fluid (CSF) parameters in term and preterm infants and described changes with advancing postnatal age, as well as in special circumstances, such as traumatic lumbar puncture (LP), previous antibiotic administration, seizures, and concomitant infections at other sites. Although guidelines exist for the interpretation of CSF parameters in neonates, there appears to be no single combination of parameters that conclusively excludes meningitis. It remains important for clinicians to perform LPs early in the course of illness, ideally before the administration of antibiotic therapy. This review presents currently available literature on the indications for LP as well as guidelines for the interpretation of CSF parameters in neonates.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Cerebrospinal Fluid / metabolism*
  • Coinfection / diagnosis
  • Coinfection / drug therapy
  • Early Diagnosis
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / cerebrospinal fluid*
  • Infant, Premature, Diseases / diagnosis
  • Infant, Premature, Diseases / drug therapy
  • Intensive Care, Neonatal / methods
  • Meningitis, Bacterial / cerebrospinal fluid*
  • Meningitis, Bacterial / diagnosis
  • Meningitis, Bacterial / drug therapy
  • Practice Guidelines as Topic
  • Spinal Puncture* / adverse effects
  • Spinal Puncture* / methods
  • Spinal Puncture* / standards
  • Time-to-Treatment


  • Anti-Bacterial Agents