A newborn baby born at 37 weeks is noted to be unwell at 18 h postnatally. The mother gives a history of prolonged rupture of membranes for 36 h. The baby is feeding poorly and is jittery, with a temperature of 38°C. A clinical diagnosis of early sepsis is made and lumbar puncture is suggested on the ward round as a part of sepsis evaluation. Several publications on the use of lumbar puncture in late-onset sepsis, including a recent review article by Malbon et al,¹ suggest that lumbar puncture is an important method of investigation and should be considered in babies for >48 h old, with suspected sepsis.

We wonder whether there is sufficient evidence to justify lumbar puncture in early sepsis.

Structured clinical question

In a newborn (patient), is lumbar puncture (intervention) necessary to rule out meningitis in suspected sepsis (outcome) in the first few …