The baby's mother had syphilis shortly before she delivered. The baby needed treatment with antibiotics for at least 10 days to ensure she didn't get syphilis, but we needed to be sure the baby didn't have syphilis in the brain, so my partner, appropriately, did a spinal tap. Unfortunately, he only got a small amount of fluid out, enough to tell us that there were a few too many infection fighting white blood cells in the spinal fluid - which suggests possible brain infection - but not enough for a culture to show us what germ might be infecting the brain. My partner tried another spinal tap the next day. It was unsuccessful. Another partner then did a spinal tap the following day; she obtained enough fluid, but the fluid had blood in it and interpretation of the results was difficult.
We discussed the case with our infectious disease specialists and agreed to stop doing spinal taps and just treat the baby for awhile. Near the end of the antibiotic treatment, I was "on service" - doing the daily rounds in the NICU - and again consulted the infectious disease folks. They suggested a fourth spinal tap, to make certain there were no signs of meningitis. I groaned whenI heard that but did it anyway. Fortunately, this time we had a clean, bountiful tap and the fluid showed no signs of infection.
I suspect that many of the non- physician readers of this blog are perhaps concerned or annoyed by this plethora of spinal taps. Trust me , we weren't very happy about it either. It's one of those situations in medicine, though, where in spite of everyone's best efforts, unfortunate things happen. My partners who did the initial spinal taps are very good at doing them; in fact, they're the procedure king and queen of our NICU. But the taps just didn't go well in this baby. I would have hated it if this happened to my own baby, but even though this much trouble with spinal taps is unusual, I don't know how to guarantee it won't happen again. It's an imperfect world - a lousy, but true, excuse.