Background Despite of the high rate of doing (lumbar puncture) LP in neonatal units, the yield is very low. The incidence of early onset (<72 h) neonatal bacterial meningitis (EONM) was estimated to be approximately 0.3 per 1000 live births. One of the national standard indications for LP in neonates is raised CRP.
Aim of the study Evaluate the utility of lumbar puncture done routinely for clinically normal babies with raised CRP.
Methods Retrospective review of the indications, course, laboratory and clinical outcome of all term babies who had LP done in our unit over the last 10 years.
Results 142 newborn babies (gestation between 36 weeks) had LP done during this period in the course of sepsis and meningitis evaluation. 43 infants were excluded from the study due to incomplete medical records, none of them had meningitis. LP was done in <72 h of age in 66 babies.
None of the clinically normal babies with raised CRP had meningitis. None of the babies who had LP done <72 h had meningitis. All meningitis cases were significantly symptomatic. From 9 babies labelled meningitis only 3 babies had microbiological diagnosis of meningitis.
Conclusion Routine lumbar puncture for babies < 72 h of age may not be required in clinically normal term newborns with raised CRP. In babies with clinical sepsis, though the yield is not very high; there are no reliable clinical or laboratory markers to predict which babies will have meningitis and hence these babies would warrant a lumbar puncture.