When to Include a Lumbar Puncture in the Evaluation for Neonatal Sepsis

Abstract

Infants younger than 1 month are at risk for meningitis and may not present with classic signs such as seizures or a bulging fontanelle. Thus, a lumbar puncture should be considered during an evaluation for sepsis in newborns in specific scenarios. While the presence of bacteremia increases the likelihood of meningitis in infants, approximately one-third of cases of meningitis occur in the setting of negative blood cultures. AbstractMeningitis is a devastating infection in infants and is linked to adverse longterm outcomes. The prevalence of meningitis is variable and depends on gestational age, postnatal age, and clinical setting. Early diagnosis and treatment with appropriate antibiotics are crucial to decrease the risk of morbidity and mortality. Lumbar punctures are essential for the diagnosis of meningitis, but clinicians may defer lumbar puncture if the risk for meningitis is low or if there are substantial concerns regarding the risk associated with the procedure. Awareness of the epidemiology and microbiology of meningitis in infants, as well as valid contraindications to performing a lumbar puncture, is necessary to avoid missed diagnoses and procedurerelated adverse effects.Objectives After completing this article, readers should be able to:1. Incorporate current evidence to identify infants in the NICU and the outpatient setting who should undergo a lumbar puncture in the evaluation for suspected sepsis.2. Review the risks and contraindications associated with performing a lumbar puncture in infants.3. Discuss challenges in the interpretation of cerebrospinal fluid parameters in the setting of absent or uninterpretable cerebrospinal fluid cultures.

Accuracy of Using a Point-of-Care Glucometer for Cerebrospinal Fluid Glucose Screening in Resource-Limited Countries

“…Because the majority of neonates with concurrent CNS infection have minimal neurologic findings, 24 a CSF examination is accepted as part of the routine workup, especially for late-onset neonatal sepsis. 25 In some institutions, especially in resource-limited settings in our country, the lengthy turnaround time for diagnostic test results is a major impediment to early commencement of antibiotics that may result in substantial morbidity and neurologic sequelae, especially in the presence of meningitis. On the other hand, empirical antibiotics that provide coverage for a broad spectrum of CNS bacterial pathogens leads to overuse.…”

“…Hence, clinical assessment alone in this population is of limited value in the prediction of CNS involvement. 25,35…”

Meningitis in neonates having late onset sepsis.

“…5 Meningitis is frequently found in LOS cases in comparison to EOS while it is also found that LOS linked meningitis is usually presenting with symptoms. 4 Reported incidence of meningitis among neonatal sepsis ranges between 0.3-3% while LOS is noted to have a significant association with the presence of meningitis, found in 3-30% of the cases. 6 In all neonates having LOS, lumber puncture (LP) is commonly performed when the clinical status of the individual stabilizes.…”

“…LOS is described as systemic infection occurring beyond 1 st 72 hours following birth. 4 Any newborn with bacterial sepsis is also at risk of meningitis. 5 Meningitis is frequently found in LOS cases in comparison to EOS while it is also found that LOS linked meningitis is usually presenting with symptoms.…”

Bacterial profile and drug resistance patterns in neonates admitted with sepsis to a tertiary teaching hospital in Ethiopia

“…It is well documented that neonates with sepsis have an increased risk of developing meningitis, which on its own would deteriorates the prognosis of such neonates [5,6]. Data from both high-and low-income settings have shown that meningitis affects 0.3 to 3% of neonates with early onset neonatal sepsis [7,8] and up to 30% of cases with LONS [6,[9][10][11].…”