What is a lumbar puncture?

Lumbar puncture is a surgical procedure mainly used to examine the lumbar spine and sepsis. Premature infants should undergo lumbar puncture examination in particular to avoid symptoms such as neurological infection and cerebrospinal fluid. Regarding the reasons and practices of lumbar puncture, everyone should choose a large hospital for examination, because this practice has certain risks and requires good pre-operative care.

Necessity of lumbar puncture

Who wants to pierce the human body for no reason? However, since the protective barrier of the infant's brain is not fully developed, systemic infection can easily spread to the brain. Surveys show that neonatal sepsis (a systemic infection in which bacteria multiply in the blood) has about a 50% chance of developing meningitis, especially in premature infants. If an infection occurs in the nervous system, the course of treatment needs to be extended and the dosage increased so that the drug in the brain reaches a therapeutic concentration and the infection is completely eliminated, otherwise there will be endless troubles. If there is no nervous system infection, there is no need to increase the dose to avoid more drug side effects. Lumbar puncture can also help doctors determine what type of infection it is, and is a very important part of the examination. Of course, in some special diseases, lumbar puncture is still a way to provide drug treatment. Therefore, lumbar puncture is very necessary.

2. Safety of lumbar puncture

If I say that lumbar puncture is just like getting an injection in the head or foot, I guess not many people would believe me. Believe it or not, it's really not as complicated as you think. Let’s look at the anatomy first.

As shown in the figure, the red area is cerebrospinal fluid, and the area A in the middle is the brain. The cerebrospinal fluid is produced in area B, flows in the direction of the arrow, and perfuses the entire brain, playing a nutritional role for the brain and is absorbed on the surface of the brain (C). In addition, cerebrospinal fluid plays a shock-absorbing role during exercise. Isn’t this shock-absorbing design ingenious? This is how car seats should be designed. If there is inflammation or infection in the brain, there will be changes in the cerebrospinal fluid. Of course, we don't puncture areas of the brain. Cerebrospinal fluid also surrounds the entire spine. We choose the most distal location where there are no important nerves for puncture.

3. How to perform lumbar puncture

This position must be taken before puncture, so two people are needed to work together, one to fix the child and the other to be responsible for the puncture. The puncture is done by inserting the needle into the space between two vertebrae. As long as the positioning is accurate, the success rate is very high and will not be lower than that of intravenous injection. The gaps in newborns are smaller and shallower, making them more susceptible to damage. Generally, we will perform the operation when the child is relatively stable. We will give the child some comfort before the operation and try to be gentle. There will also be life monitoring and observation during the operation so as not to affect the child.

4. What should not be done?

If the child's vital signs are unstable and require emergency treatment, if the coagulation function is significantly abnormal, if there is active intracranial bleeding, or if the puncture site is not suitable such as a mass or infection, puncture cannot be performed.

5. Is it necessary to avoid lumbar puncture and treat it as a nervous system infection?

I believe everyone knows whether lumbar puncture is more dangerous or excessive and prolonged antibiotic treatment is more harmful.