1 Kaiser Permanente Medical Care Program, Division of Research, Health Services Research—Neonatal Unit, Oakland, CA 94611
Dr Wiswell does well to remind us that selective criteria for lumbar puncture sometimes fail to identify cases of neonatal meningitis (Pediatrics 1995;95:803-806). It should not surprise us when a guideline fails. However, it does not follow that, because of this observation, one should subject every newborn suspected of sepsis (130 000 to 400 000 each year in the United States1-3) to a spinal tap. The history of neonatology is full of unfortunate events resulting from similar blanket recommendations.4