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Serious bacterial infections in febrile infants and children selected for lumbar puncture

E D Barnett1, H Bauchner, D W Teele

  • 1Maxwell Finland Laboratory for Infectious Diseases, Boston City Hospital, MA 02118.

The Pediatric Infectious Disease Journal
|November 1, 1994
PubMed

Insights

Lumbar puncture (LP) in febrile children can reveal meningitis or other serious bacterial infections. For children under two with normal cerebrospinal fluid, blood, urine, and stool cultures are recommended.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Emergency Medicine

Background:

  • Lumbar puncture (LP) is a common procedure in pediatric emergency departments for diagnosing meningitis in febrile infants and young children.
  • Children undergoing LP may have other serious bacterial infections even if meningitis is not present.

Purpose of the Study:

  • To survey lumbar punctures performed in a pediatric emergency department.
  • To monitor the incidence of meningitis and other serious bacterial infections in children undergoing LP.

Main Methods:

  • Retrospective survey of lumbar punctures performed at Boston City Hospital Pediatric Emergency Department.
  • Monitoring of meningitis diagnosis and positive cultures (blood, urine, stool) in children with normal cerebrospinal fluid.

Main Results:

  • Meningitis was diagnosed in 8% of children who underwent LP.
  • An additional 10.5% of children with normal cerebrospinal fluid had positive blood (3.1%), urine (4.1%), or stool (3.3%) cultures.
  • The decision to perform LP identifies children at risk for serious bacterial illnesses beyond meningitis.

Conclusions:

  • Children undergoing lumbar puncture are at risk for both meningitis and other serious bacterial infections.
  • For children aged 2 years and younger with normal cerebrospinal fluid after LP, consider blood, urine, and possibly stool cultures to detect other infections.

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