Evaluation of routine lumbar punctures in newborn infants with respiratory distress syndrome

Eldadah, Maher K.; Frenkel, Lawrence D.; Hiatt, I Mark; Hegyi, Thomas

doi:10.1097/00006454-198703000-00005

Cited by 54 publications

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“…Blood cultures were positive in three of the four cases of meningitis. They concluded, as did Eldadah et al 6 in 1987, that LP should be reserved for infants with positive blood cultures, central nervous system symptoms, or positive urine GBS antigen test results. Schwersenski et al 10 showed similar findings, but also noted that the yield of LP increased fivefold when performed in symptomatic infants after the first week of life.…”

Section: Discussionmentioning

confidence: 92%

“…GBS sepsis has a high incidence of coexistent meningitis; therefore, an LP to exclude the possibility of meningitis has traditionally been included in the evaluation of newborns born to GBS-colonized women who have fever or prolonged rupture of membranes, although previous studies have been in mixed preterm and full-term infants, [5][6][7] whereas ours was exclusively in full-term newborns. In our study, 3423 LPs were done in asymptomatic full-term infants, of which none revealed meningitis, but 35 had contaminants (0.96%).…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Lumbar puncture (LP) is often performed immediately after delivery in asymptomatic newborns after chemoprophylaxis as part of a sepsis evaluation to diagnose bacterial meningitis. However, the studies evaluating the clinical usefulness of LP have been done primarily in preterm infants [5][6][7] or in neonatal intensive care units with both full-term and preterm infants. 8 -10 It may not be appropriate to generalize the findings from high-risk populations to asymptomatic full-term infants cared for in general nurseries.…”

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confidence: 99%

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Term Newborns Who Are at Risk for Sepsis: Are Lumbar Punctures Necessary?

et al. 1997

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ABSTRACT. Objectives. To determine: (1) whether a lumbar puncture (LP) is indicated in asymptomatic fullterm newborns delivered by mothers at risk of intrapartum sepsis; and (2) whether gentamicin improves bacterial coverage for such newborns when used with ampicillin.Design. A retrospective chart review from 1987 through 1993 of all newborns with positive blood and/or cerebrospinal fluid cultures in the first 7 days of life.Methods. Pregnant women were screened in the second trimester for group B streptococci and given ampicillin during labor if two or more risk factors were present: group B streptococci colonization, maternal fever or leukocytosis, rupture of membranes at more than 18 hours, foul-smelling amniotic fluid, and fetal tachycardia. After sepsis evaluation (LP, blood culture, white blood cell count, and differential), asymptomatic infants received ampicillin and gentamicin for 48 to 72 hours unless cultures grew pathogens.Results. Of approximately 24 452 full-term births in 7 years, 7% (1712) had evaluations for symptoms of sepsis, and 14% (3423) were asymptomatic but had evaluations for maternal risk factors. There were 11 cases of meningitis, all involving symptomatic newborns; 10 of these 11 had positive blood cultures for the same organism. In asymptomatic infants, none of the 3423 had meningitis (95% confidence interval, 0 to 0.0008), although 35 grew contaminants. Of 73 pathogens isolated from blood or cerebrospinal fluid, 7 (9.5%) were resistant to ampicillin. Addition of gentamicin provided coverage for only 2 of these 7 pathogens. Of 5135 infants who received ampicillin and gentamicin, only 2 required gentamicin for improved coverage.Conclusions.(1) LP is unnecessary in asymptomatic full-term newborns. (2) Empiric coverage for asymptomatic newborns with maternal risk factors need not include gentamicin at all hospitals, because it only improved the coverage of ampicillin alone from 90% to 93% of pathogens, but it exposed more than 5000 infants to the side effects of gentamicin. (3) The presence of leukopenia (<5000 white blood cells/mm 3 ) is highly predictive of bacteremia. Pediatrics 1997;99(4). URL: http://www. pediatrics.org/cgi/content/full/99/4/e10; newborn, lumbar puncture, meningitis.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Term Newborns Who Are at Risk for Sepsis: Are Lumbar Punctures Necessary?

et al. 1997

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“…The risk of concomitant meningitis in high-risk neonates who appear healthy or those whose clinical signs appear to be due to noninfectious conditions such as RDS is very low (111,164).…”

Section: Cerebrospinal Fluid Testingmentioning

confidence: 99%

Early-Onset Neonatal Sepsis

et al. 2014

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SUMMARY Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.

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“…38 In the infant with clinical signs that are thought to be attributable to a noninfectious condition, such as respiratory distress syndrome, the likelihood of meningitis is also low. 39 However, in bacteremic infants, the incidence of meningitis may be as high as 23%. 40,41 Blood culture alone cannot be used to decide who needs a lumbar puncture, because blood cultures can be negative in up to 38% of infants with meningitis.…”

Section: Lumbar Puncturementioning

confidence: 99%

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Polin¹,

Newborn²

2012

Pediatrics

693

433

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With improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. The identification of neonates at risk for early-onset sepsis is frequently based on a constellation of perinatal risk factors that are neither sensitive nor specific. Furthermore, diagnostic tests for neonatal sepsis have a poor positive predictive accuracy. As a result, clinicians often treat well-appearing infants for extended periods of time, even when bacterial cultures are negative. The optimal treatment of infants with suspected early-onset sepsis is broad-spectrum antimicrobial agents (ampicillin and an aminoglycoside). Once a pathogen is identified, antimicrobial therapy should be narrowed (unless synergism is needed). Recent data suggest an association between prolonged empirical treatment of preterm infants (≥5 days) with broad-spectrum antibiotics and higher risks of late onset sepsis, necrotizing enterocolitis, and mortality. To reduce these risks, antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low. The purpose of this clinical report is to provide a practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis. Pediatrics

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Evaluation of routine lumbar punctures in newborn infants with respiratory distress syndrome

Cited by 54 publications

References 0 publications

Term Newborns Who Are at Risk for Sepsis: Are Lumbar Punctures Necessary?

Term Newborns Who Are at Risk for Sepsis: Are Lumbar Punctures Necessary?

Early-Onset Neonatal Sepsis

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

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