The diagnostic utility of lumbar punctures in neonates was evaluated in the Division of Neonatology, Department of Pediatrics, University of Miami, FL. Of 712 neonates with lumbar punctures during the first week of life, 8 had positive spinal fluid cultures but only 1 had a positive blood culture and a clinical course consistent with meningitis. In contrast, of 114 patients who underwent lumbar punctures after the first week of life, 7% had a positive culture approximating 5 times that observed during the first week of life. [1]

COMMENT. The authors conclude that the routine use of lumbar puncture as a part of the work-up for infection during the first week of life in an asymptomatic neonate should be reassessed. The results of the study suggest that lumbar puncture may not be justified in an asymptomatic at-risk neonate during the first week of life but after the first week lumbar puncture may be indicated in the at-risk infant.