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Is a lumbar puncture a necessary investigation in a 2-month-old infant with a probable urinary tract infection?
  1. Jennifer Margaret Jamieson,
  2. Thomas Christie Williams
  1. Royal Hospital for Children and Young People, Edinburgh, UK
  1. Correspondence to Dr Jennifer Margaret Jamieson, Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK; jennifer.jamieson{at}nhslothian.scot.nhs.uk

https://doi.org/10.1136/archdischild-2021-322436

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    Clinical scenario

    A 2-month-old child is brought to the emergency department with a 24-hour history of fever (≥38°C) and being non-specifically unwell. She looks well on examination. Urine microscopy reveals organisms and white cells, and a full blood count shows a white cell count of 16×109/L. National Institute for Health and Care Excellence (NICE) guidelines1 currently recommend that a lumbar puncture be performed as part of their assessment, but you question whether this additional invasive procedure is in the patient’s best interests.

    Clinical question

    In a child 1–3 months old with fever, positive urine microscopy and no clinical features of meningitis (population), what is the likelihood of diagnosing meningitis (outcome) following lumbar puncture (intervention)?

    Search criteria

    PubMed and Cochrane were searched using “Paediatric+Urinary tract infection+Meningitis” and found 85 hits, of which 7 were relevant.

    Commentary

    What is the problem?

    As a paediatrician, it is not uncommon to assess an infant aged 1–3 months in the emergency …

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    Footnotes

    • Twitter @Williams_T_C

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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