What Happens When We Miss? Effect of Initial Lumbar Puncture Success on Infant Sepsis Evaluation

Lumbar punctures (LPs) are a common part of infant sepsis evaluations. Failures are estimated at 12% to 40%. Given limited literature on this topic, we describe characteristics, management, and outcomes for infants undergoing sepsis workup with successful vs unsuccessful initial LPs, including those who underwent repeat LP attempt.

We conducted a retrospective cross-sectional study of infants aged 0 to 60 days with LP performed during sepsis evaluation. Infants admitted to intensive care units, transferred from another hospital's inpatient unit, or with medical complexity were excluded. Descriptive statistics and logistic regression were performed.

Of 468 infants, 386 had a successful initial LP (82%). Length of stay (LOS) was longer in infants with an unsuccessful initial LP (P = 0.02). Demographics, length of antibiotics, and readmission rate did not differ between groups. Infants with successful initial LPs were less likely to have viral testing (P = 0.019) and had shorter acyclovir courses (P = 0.026). Only 43% of infants with an unsuccessful initial LP underwent repeat LP attempt. Increased inflammatory markers were associated with repeat LP attempt.

Infants with unsuccessful initial LPs had increased LOS and resource use. Elevated inflammatory markers were associated with repeat LP attempt, and infants with repeat LPs had higher medical utilization. Prospective or multicenter studies are needed to further investigate outcomes and decision-making for infants with unsuccessful LPs and inform guidelines regarding repeat LPs.