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Question 2: Is a lumbar puncture necessary in an afebrile newborn infant with localised skin and soft tissue infection?
  1. Rosa Nguyen1,
  2. Ramachandra Bhat1,
  3. Getachew Teshome2
  1. 1Department of Pediatrics, University of Maryland, USA
  2. 2Pediatric Emergency Medicine, University of Maryland, USA
  1. Correspondence to Dr Rosa Nguyen, Department of Pediatrics, University of Maryland, 22 S Greene Street, N5W70, Baltimore, MD 21201, USA; rosi.nguyen{at}

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A 3-week-old previously healthy full-term infant with uncomplicated perinatal course presents to the emergency room with a large perineal abscess. At home, the infant has been afebrile and otherwise well appearing. On physical examination, a 3×3 cm indurated, tender, nodular lesion with central fluctuation and surrounding erythema was noted in the right perineal region, consistent with a right perianal abscess. Initial sepsis evaluation included basic inflammatory markers and blood and urine cultures. Pus was manually expressed and sent for bacterial culture. Intravenous antibiotic treatment was initiated. The resident taking care of the baby wonders if a lumbar puncture (LP) should be performed as part of the sepsis evaluation to rule out occult meningitis.

Structured clinical question

In afebrile neonates with localised skin and soft tissue infection (POPULATION), is routine LP necessary (INTERVENTION) to evaluate for occult meningitis? (OUTCOME)


Search date: 12 April 2013. Primary source: The PubMed database and Scopus. Secondary source: The Cochrane Library.

English language literature sources were searched using either text word (tw) or medical subject subheading (MeSH): (infant, newborn (MeSH) OR neonates (tw) OR neonate (tw) AND (focal infection (MeSH) OR cellulitis (MeSH) OR soft tissue infections (MeSH) OR abscess (MeSH) OR mastitis (MeSH)) OR neonatal mastitis (tw) AND cellulitis adenitis syndrome (tw). …

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  • Contributors RN conducted the initial literature search, prepared the initial manuscript. RB conceptualised the structured clinical question and revised the manuscript. GT performed a critical review and revision of the manuscript.

  • Competing interests None.

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

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