Lumbar Puncture for All Febrile Infants 29-56 Days Old: A Retrospective Cohort Reassessment Study.

TitleLumbar Puncture for All Febrile Infants 29-56 Days Old: A Retrospective Cohort Reassessment Study.
Publication TypeJournal Article
Year of Publication2017
AuthorsScarfone R, Murray A, Gala P, Balamuth F
JournalJ Pediatr
Volume187
Start Page200
Pagination200-5
Date Published2017 Aug
ISSN1097-6833
Abstract

OBJECTIVES: To determine the incidence of bacterial meningitis (BM) among all febrile infants 29-56 days old undergoing a lumbar puncture (LP) in the emergency department of a tertiary care children's hospital and the number of low-risk febrile infants with BM to reassess the need for routine LP in these infants.

STUDY DESIGN: Retrospective cohort study using a quality improvement registry from July 2007-April 2014. Infants included were 29-56 days old with fever and who had an LP in the emergency department. Low-risk criteria were adapted from the Philadelphia criteria. BM was defined as having a bacterial pathogen isolated from the cerebrospinal fluid. A medical record review of one-third of randomly selected patients in the cohort determined the proportion who met low-risk criteria.

RESULTS: One of 1188 febrile infants (0.08%) had BM; this patient did not meet low-risk criteria. An additional 40 (3.4%) had positive cerebrospinal fluid cultures; all were contaminants. Subanalysis of one-third of the study population revealed that 45.6% met low-risk criteria; the most common reasons for failing low-risk classification included abnormal white blood cell count or urinalysis.

CONCLUSIONS: In a cohort of febrile infants, BM is uncommon and no cases of BM would have been missed had LPs not been performed in those meeting low-risk criteria.

DOI10.1016/j.jpeds.2017.04.003
Alternate JournalJ. Pediatr.
PubMed ID28526220