Dr. Rapkin's article1 makes an important contribution to the diagnostic approach to children with acute infectious illnesses. The findings of meningitis on repeat lumbar puncture point out the need for continued vigilance even after an initially negative LP. However, his suggestion that "a positive blood culture mandates a repeat LP" can perhaps be modified by a review of the child's clinical condition at the time a positive blood culture is reported. Patients 1 through 4 in his report all displayed central nervous system abnormalities—convulsions, lethargy, apnea—before the blood culture was reported as positive.