Paeds Vivas · investigations-procedures-and-technology
Lumbar puncture in infants and children — branching viva
Branching viva on lumbar puncture in infants and children: pre-procedure assessment, positioning and technique, the antibiotics-first rule in suspected bacterial meningitis, the opening pressure and its reliability, and the management of post-dural puncture headache.
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Target exams
RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Emergency department: a 4-month-old febrile infant with irritability and a full fontanelle needs a diagnostic lumbar puncture as part of a septic workup. The examiner asks how you would assess and prepare for the procedure, what positioning and needle you would choose, and how you would obtain a reliable opening pressure — then branches to the child who develops signs of raised intracranial pressure just as the LP is planned, to the CSF interpretation including a traumatic tap, and finally to the management of post-dural puncture headache.
Opening question
This 4-month-old febrile infant with irritability and a full fontanelle needs a diagnostic lumbar puncture. Walk me through the structured pre-LP assessment you would perform, and tell me what would make you image before the LP rather than proceed. [1]
References4ShowHide
- [1]Schulga P, Grattan R, Napier C, et al. How to use… lumbar puncture in children Arch Dis Child Educ Pract Ed, 2015.PMID 26104280
- [2]Rao S Atraumatic lumbar puncture needles are associated with fewer complications than conventional needles Arch Dis Child Educ Pract Ed, 2019.PMID 30368456
- [3]Cartwright C, Igbaseimokumo U Lumbar puncture opening pressure is not a reliable measure of intracranial pressure in children J Child Neurol, 2015.PMID 24799366
- [4]Visintin C, Mugglestone MA, Fields EJ, et al. Management of bacterial meningitis and meningococcal septicaemia in children and young people: summary of NICE guidance BMJ, 2010.PMID 20584794