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Baby and spinal tap



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amother
Mint


 

Post Sun, Nov 19 2017, 7:54 am
My baby is 4 weeks old and had a fever of 100.0 then went up to 101.4 took her to ER and they did tests said she has a virus.
They still want to do a spinal tap on her.
I don't know what to do, if they ruled a virus then why do a spinal tap.
Anyone have experience?
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mammala120




 
 
    
 

Post Sun, Nov 19 2017, 9:06 am
Spinal tap done to check for meningitis. If her fever is under control and she stable don't do the tap. It has its own risks. Tell the hospital that her vitals are stable and you will take her care further in outpatient facilities under her primary doctor. Refuah shelema.
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rydys




 
 
    
 

Post Sun, Nov 19 2017, 9:57 am
The tests that they did were probably a cbc and urine screen. These tests cannot definitively rule out a bacterial infection but can predict the likelihood of bacterial vs viral infection. Even with a viral nose swab that shows viral, there is still a risk of bacterial infection, although small. The best way to really rule out bacterial infection at that age is through cultures, which take 2-5 days to grow (think rapid strep vs overnight culture).

At 4 weeks the baby's immune system is still very weak and a small infection is likely to spread very quickly. The blood/brain barrier is also weak so a simple infection can more easily pass through to the brain/spinal cord. Newborns do not generate fever easily so when they do we take it very seriously.

In any child under 2 months with fever I would definitely check the blood, the urine and the spinal fluid to make sure that there is no bacterial infection (and yes, I have done this on my own children). The spinal tap has its risks, but the risk of missed infection is greater.

In a 4 week old I would also admit for IV antibiotics until we had the cultures back (48 hours), here's why. Lets say the baby is admitted, started on IV antibiotics and after 48 hours the cultures are negative. We stop the antibiotics and the baby goes home. On the other hand, lets say we either don't do a full workup or even if we do, we don't start antibiotics and the baby really has an infection. By the time we get the cultures back it might be too late to do anything and the baby will suffer severe long lasting damage or worse, C"V.

Newborns have weak immune systems but also do not follow the same path of illness as older children or adults. I have seen babies who look fine, are alert, feeding well, etc. who crash and become deathly ill within 10-15 minutes. And not all of those babies have survived.

When looking at the risk/benefit ratio, the small risk of spinal tap, admission and antibiotics is much smaller than the risk of losing a child.
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nursemomma




 
 
    
 

Post Sun, Nov 19 2017, 10:08 am
What rydys said.
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amother
Mint


 

Post Sun, Nov 19 2017, 10:13 am
So I am so mad.

I didn't want a spinal tap but they said it is necessary so in the end I said yes but they tried to do it an couldn't so then they said it probably doesn't have to be done. After they poked her.
They said that she should stay for observation.

I am just so mad.
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mammala120




 
 
    
 

Post Sun, Nov 19 2017, 11:36 am
amother wrote:
So I am so mad.

I didn't want a spinal tap but they said it is necessary so in the end I said yes but they tried to do it an couldn't so then they said it probably doesn't have to be done. After they poked her.
They said that she should stay for observation.

I am just so mad.


Let me guess. Is that in Maimonides??? They use only student residents. That's why I mentioned doing it outpatient with your doctors guidance. Find professional
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rydys




 
 
    
 

Post Sun, Nov 19 2017, 4:15 pm
mammala120 wrote:
Let me guess. Is that in Maimonides??? They use only student residents. That's why I mentioned doing it outpatient with your doctors guidance. Find professional


Just about every hospital in NYC is a teaching hospital and uses residents. A resident will be closely supervised by an attending (aka experienced doctor) until he is proficient at the procedure. If the resident has difficulty he will be guided by an attending or the attending will take over. Maimonides is no different than NYU or Cornell or Columbia. As a matter of fact, residents may have better supervision at a smaller hospital that is not as busy as the major medical centers.

As far as doing it outpatient, as I mentioned above the baby really needs to be admitted for IV antibiotics until the cultures come back. In addition, by this time of year, the residents who spend weeks doing spinal taps over and over are probably more proficient than the private, outpatient doctors who have not done one in years. As a resident and ER attending I loved doing spinal taps. They were one of my favorite procedures and I did tons of them. Now, over 10 years since my last one, although I still "know" how to do it, I would not be comfortable attempting it without supervision.

In terms of going without when it does not go well, that is a wise decision. As mentioned above, in medicine we are always weighing the risks and benefits of a decision. It's true that it is important to get the spinal fluid culture, but there are risks to the spinal tap as well, although they are usually minimal. If things are not going well then it may reach a point where the risks of the tap exceed the benefit of the culture and a smart doctor will stop before risking harm to the patient.

Medicine and medical decisions are rarely black and white. Even something as "simple" as a strep throat or ear infection requires thought, understanding and experience to decide how and when to treat. This comes from many years of studying accompanied by practice, apprenticeship and training, not just reading books or "researching" on the internet.
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