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Lumbar Puncture for All Febrile Infants 29-56 Days Old: A Retrospective Cohort Reassessment Study
Richard Scarfone1, Ashlee Murray1, Payal Gala1
1Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA.
Insights
Bacterial meningitis (BM) is rare in febrile infants 29-56 days old. Routine lumbar puncture (LP) may be safely avoided in low-risk infants, as no BM cases were missed in this group.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Febrile infants aged 29-56 days often undergo lumbar puncture (LP) to rule out bacterial meningitis (BM).
- Reassessing the necessity of routine LP in low-risk febrile infants is crucial for optimizing clinical practice.
Purpose of the Study:
- To determine the incidence of BM in febrile infants (29-56 days) undergoing LP.
- To evaluate the number of low-risk febrile infants with BM to inform decisions about routine LP.
Main Methods:
- Retrospective cohort study (July 2007-April 2014) of febrile infants (29-56 days) with LP.
- Utilized a quality improvement registry and adapted Philadelphia criteria for low-risk classification.
- Medical record review of a subset to determine adherence to low-risk criteria.
Main Results:
- BM incidence was 0.08% (1 of 1188 infants); this infant did not meet low-risk criteria.
- 3.4% had positive cerebrospinal fluid cultures, identified as contaminants.
- 45.6% met low-risk criteria, commonly failing due to abnormal WBC count or urinalysis.
Conclusions:
- Bacterial meningitis is uncommon in this febrile infant cohort.
- Routine LP could have been avoided in infants meeting low-risk criteria without missing any BM cases.
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.
