40 PEADS Meningitis

Lumbar puncture (Meningitis)

  • Lumbar puncture (LP) is performed at or below the L4 level
  • The conus medullaris finishes near L3 at birth, but at L1-2 by adulthood
  • The decision to perform LP should generally be discussed with a senior clinician
  • It is preferable to obtain a CSF specimen prior to antibiotic administration; however, antibiotics must not be unduly delayed in a child with signs of meningitis or sepsis
  • In a child with fever and purpura, in whom meningococcal infection is suspected, LP may not change the management and may cause deterioration
  • In term infants, the seated position has been shown to be the best tolerated and to also have the best chance of obtaining CSF
  • If an LP is unsuccessful on two occasions, refer to a senior colleague, reassess the need for LP and consider image guidance to assist
  • CT scans are not helpful in most children with meningitis; a normal CT scan does not exclude raised intracranial pressure (ICP) and brain herniation may occur even in the presence of a normal CT scan


  1. Ismail, H.I.H.M., Ibrahim, H.M., Ng, H.P., Kesihatan, M.K. and Thomas, T. (2019) Paediatric Protocols for Malaysian Hospitals. 4th Edition, Ministry of Health, Putrajaya.
  2. https://www.rch.org.au/clinicalguide/guideline_index/Lumbar_puncture/