Lumber Puncture in early onset sepsis

[rehman_naveed]

Is there any recent study after 2006 or any recent evidence addressing this issue of " lumber puncture in early onset sepsis in neonate".
Regards

[salameh101]

Because of the low incidence of meningitis in the newborn infant with negative blood culture results, clinicians may elect to culture the CSF of only those infants with documented or presumed sepsis. However, recent data in large numbers of patients show a 38% rate of culture-positive meningitis in neonates with negative blood culture results and suspected sepsis. Therefore, a lumbar puncture should be part of the evaluation of an infant with suspected sepsis.
Intrpartum antibiotic may cause negative culture in some pt with real sepsis or meningitis.

[fcardona]

Could you quote the article you base your numbers on? We - admittingly - rarely perform a lumbar puncture at our ward and I am interested to read up on the available data.

[rehman_naveed]

My question is whether or not to do lumber puncture in early onset sepsis, not in sepsis per se. Say for example in one day old or two days old baby admitted with respiratory distress?

[Stefan Johansson]

interesting discussion! I also admit that we rarely do an lp in early susp sepsis. However, in a child who seem to be septic (altered conscious, in need of mech vent for example), when the crp exceeds 100, we usually do lp as part of the septic screen.
But, in the majority of infants, lp is not done.

[feraszaman]

Well, although I don't have the article at this moment but let me tell when we/I dp LP for an infant
late onset sepsis: i.e > 3-7 DOL with or without picc lines or broviac's or any central lines we do the full sepsis workup (BloodCx, Urine Cx and CSF) that if we dont have a source for the infection like an example : 15 days old with Picc line just taking everything by mouth and got sick,apnic, shocky AXR showed Pneumatosis; we consider this NEC and NO LP but if we couldn't find a good reason ..we do LP in addition to the old/new question : to remove or not to remove the Picc line..of course depends on what Bug and how long it has been placed etc.. 38% of blood cx might be negative with meningitis as what Dr.Salameh101 mentioed above which I believe came from a huge study 7-8 years ago but it was multicenter study and the cultures were from different labs and not a unified method
for early onset sepsis: we do it in infants with chorioamnionitis or severly depressed infant with no obvious reason (like HIE..) ..anyway: if you asked 3 neontalogist about when to perform LP, you'll get 7 different answers !!

[rehman_naveed]

I thank every one with their valuable suggestions. What I concluded from this discussion that Lumbar puncture is Opinion based and not an evidenced based especially in early onset sepsis. Early onset sepsis needs LP when high suspicion of chorioamnionitis, GBS positive mother with symptomatic baby, mother having fever and symtomatic baby.
Regarding late onset sepsis LP should be and must be a part of septic work up ( what we call as triple tap, blood Cs, Urine Cs and CSF CS) unless clear cut cause is there like NEC, Pneumonia, cellulitis, osteomyelitis etc and of course depending on the bug isoloated, LP can be done retrospectively