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Indicators for lumbar puncture in well – looking neonates; evidence from a national questionnaire – based survey

Presented at the Neonatal Society 2018 Summer Meeting.

Fareed S, Yasin F, Khan R

Department of Paediatrics, University Hospital Limerick, Limerick

Background: The incidence of early onset neonatal bacterial meningitis (EONM) was estimated to be approximately 0.3 per 1000 live births. Sign of EONM in term infants typically present by first 6 hrs and the majority presents within the first 24hr of life. Diagnostic investigations varies widely. However rationale to do lumbar puncture in well looking neonates with raised CRP varies widely.

Methods: To perform a national survey via questionnaire to all paediatric consultant and neonatologist in Republic of Ireland. Questionnaire consists of questions regarding indication of lumbar puncture in well looking neonates with raised CRP and what level of CRP is indicative for lumbar puncture.

Results: 97 questionnaires were sent. Response rate was 50%. 54% were from general Paediatric consultants, 30% from Neonatologist, 4% from Neurologist and 12% were unmentioned. 56 % will do lumbar puncture (LP) in well looking child with CRP >20. 35% will make decision of LP with clinical assessment of the neonates alone. In case of Clinical condition and elevated CRP, 33% will always do LP as compared to 50% who sometimes do LP and look for other blood markers. In case of positive blood culture and +/- positive blood PCR 56% will do the LP in stable neonates. According to survey 75% of the LP decisions were made by clinicians without considering any international guidelines.

Conclusion: The decision to perform a lumbar puncture in neonate with suspected EONM remains unclear. In the high risk and healthy appearing babies, the data suggest that likelihood of meningitis is extremely low. Most clinicians employ CRP as a complementary indicator to clinical decision rather than sole determinant of lumbar puncture in otherwise well babies. However many clinicians do use it sometimes to gear the decision. Absolute solution can only be yielded after outcome of lumbar puncture justifies the role of CRP, Guidelines through national consensus and neonatal clinical advisory group are recommended.

Corresponding author: Sheikdr@yahoo.com

References
1. http://adc.bmj.com/content/99/Suppl_1/A172.2
2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082975 

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