What does lumbar puncture in infants check?

Lumbar puncture is usually done on babies to check whether there are any lesions in the nervous system, such as the brain, meninges and spinal cord. Many parents have misunderstandings about lumbar puncture, thinking that lumbar puncture will make the baby stupid. In fact, there is no scientific basis for this. Lumbar puncture is a traumatic examination and will cause certain pain to the child. However, after the examination, the child needs to rest well and must be well taken care of.

Lumbar puncture is the abbreviation of lumbar puncture. A basic test doctors do to check for problems in the nervous system (including the brain, meninges, and spinal cord). The method is to let the sick child lie on his side, hold his legs with both hands and bend his head towards his chest. The purpose is to make the spine bend as much as possible to expose the intervertebral space. After local skin disinfection, the doctor holds a thin lumbar puncture needle and inserts it through the skin into the spinal cavity. If the operation goes smoothly, when the needle tip reaches the predetermined position, the needle core is pulled out, and normally a white transparent liquid (i.e. cerebrospinal fluid) will slowly flow out. The doctor needs to measure the cerebrospinal fluid pressure or calculate the number of drops of cerebrospinal fluid flowing out per minute. Generally, three small bottles (about 2 to 3 ml each) are retained to send the cerebrospinal fluid for routine examination, biochemical index examination and bacterial culture. The disease is diagnosed based on the results of the cerebrospinal fluid examination. Generally, when there is inflammation of the meninges and spinal cord membranes, the cerebrospinal fluid is often turbid, and white blood cells can be found under a microscope, and the protein test can be increased. If it is a viral infection, the cerebrospinal fluid is often frosted, and the protein and cell counts are increased. If there is a bacterial infection, the cerebrospinal fluid is often rice soup-like, with hundreds or thousands of cells, and even pus clots, and the amount of protein is greatly increased. However, to determine which bacteria are causing the disease, a cerebrospinal fluid smear or bacterial culture is required to confirm the diagnosis.

Lumbar puncture is a basic operation for a doctor. For anesthesiologists and neurologists, since almost every patient has to undergo this examination, they are familiar with the surgical operation and have a higher success rate. However, in pediatrics, especially infants and young children, they do not understand the significance of the examination and are very uncooperative. This is especially because the examination should be performed in a relatively clean or sterile treatment room. Parents are often unable to accompany their children, and the operation is sometimes difficult, and it is even impossible to correctly puncture the spinal cavity and successfully obtain cerebrospinal fluid. If this test is necessary for diagnosis, it should be done after the child has taken a sedative and is asleep.

Many parents have doubts about lumbar puncture, mainly because they have listened to some misunderstandings of folk legends, such as lumbar puncture can make children stupid. Some people also mistakenly believe that lumbar puncture is to extract bone marrow. In fact, these legends are all wrong. Lumbar puncture is to obtain cerebrospinal fluid for examination; while bone marrow puncture is to obtain bone marrow for examination. Doctors have to do this type of examination when suffering from malignant tumors such as leukemia, or when high fever and other reasons have not been cured for a long time and it is necessary to rule out malignant tumors.

In fact, lumbar puncture itself is just like puncturing a blood vessel to draw blood. It is a detection method to take out fluid from a certain part of the body and check whether there are any abnormal changes in the organs and tissues through which it flows. If the cerebrospinal fluid examination is normal and neurological diseases are ruled out, there will be no sequelae and the child will not become stupid. If cerebrospinal fluid examination proves that there is a disease in the nervous system, there will often be different sequelae depending on the nature of the lesion, the early or late onset of fever, or whether the treatment is thorough or not, such as hydrocephalus, mental retardation caused by brain cell necrosis, limb paralysis, etc. These are not caused by lumbar puncture, but by diseases of the nervous system. In our clinical work, we often encounter parents with low educational level, who do not understand the necessity of some examination methods, are stubborn and resolutely refuse to do lumbar puncture. Because the parents firmly disagree, the doctor cannot make a correct diagnosis of the disease, and the treatment is very blind, which affects the treatment. It is not until the child develops convulsions or coma that a lumbar puncture is done, but it is too late. Often after rescue, the sick child still has serious sequelae, and the parents regret it.

Of course, lumbar puncture is a invasive examination that will cause some pain to the child, and it is only part of a variety of examinations. Before performing a lumbar puncture, the doctor should try to understand the child's medical history, examine the child's various symptoms, repeatedly explain to the parents the purpose and significance of the examination, and obtain the parents' close cooperation.