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Should repeat lumbar punctures be routinely done in neonates with bacterial meningitis? Results of a survey into clinical practice
  1. R AGARWAL,
  2. A J B EMMERSON
  1. St Mary's Hospital, Whitworth Park
  2. Manchester, UK
  3. anthony.emmerson{at}man.ac.uk

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    Editor,—Neonatal meningitis remains a very important cause of morbidity and mortality, with 30% death or handicap rate reported in a recent study.1 In common with other clinical situations, the evidence base for some of the management recommendations for good clinical practice is hard to find. One particular aspect of the management of neonatal bacterial meningitis is whether or not a repeat lumbar puncture should be undertaken routinely. Several standard textbooks of neonatology2 3 recommend repeating the lumbar puncture routinely in the course of neonatal bacterial meningitis, to ensure that “meningitis” continues to improve. This recommendation is based on past practice, and current evidence in favour or against repeating the lumbar puncture in neonatal bacterial meningitis is lacking.

    However, we have observed that day to day clinical practice appears to have changed and fewer repeat lumbar punctures are being done. To investigate this we performed a simple questionnaire survey across the north west of England to determine the opinion of currently practising/trainee paediatricians and neonatologists. Table 1 shows the results of the survey.

    Table 1

    Results of the questionnaire survey

    The response rate of 65% is a representative response for this type of survey. There was a good mix of experience—58% consultants and 42% trainees in paediatrics/neonatology; 47% had more than 10 years neonatal experience (table 2).

    Table 2

    Breakdown of those who responded

    Many textbooks reflect past practices, especially when there is little new published evidence to support a change, yet in some circumstances day to day clinical practice is quite different from that promulgated in the standard texts. In an era of a demand for evidence based practice and an ever increasing level of litigation it is clearly important that current practice based on experience is reflected appropriately. This study shows that there is a widely held and practised view that routinely repeating lumbar punctures in neonates with bacterial meningitis is not appropriate and that a selective approach to repeating the lumbar puncture based on the clinical situation is the preferred option. This opinion was reflected by both those with long experience and in the teaching hospitals as well as by those practising in district general hospitals and trainees in paediatrics/neonatology. A national clinical survey of the outcome for infants with meningitis under different management practices should be carried out.

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