A baby born at 28 weeks gestation initially has no respiratory disease and is breathing spontaneously in room air. On day 6 of life the baby develops increasingly frequent and severe apnoeas and episodes of bradycardia that are mostly self-limiting. In view of this, nasal continuous positive airway pressure is started, a blood culture taken, and broad spectrum antibiotics commenced. On the ward round the next morning there is a debate as to whether a lumbar puncture (LP) should also have been performed, as part of the investigations for bacterial infection. The registrar opines that this was considered, but that the baby was thought “too unstable” for the procedure.

If an LP is performed routinely as part of the investigations for infection, how often will it be informative?

Structured clinical question

In neonates [patient] what is the incidence of meningitis [outcome] in late onset infection [greater than 48 hours]?

Search strategy

Secondary sources: Cochrane and Dare: no relevant results.

Primary sources: searched Medline, Pubmed, Embase and CINAHL databases via Dialog Datastar with the search criteria detailed in table 1.

Number of hits: 26, of which five were relevant clinical studies.

Reviews and …