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G410(P) Is what we do rationale? Is lumbar puncture indicated in well looking term newborns < 72 hours age with high CRP values?
  1. H Abdelrhim,
  2. P Heaton
  1. Paediatric Department, Yeovil District Hospital, Yeovil, UK


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. Series of reports have shown that with improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy EONM is becoming less frequent. For instance, a prospective surveillance study was done, in 20 neonatal units in Australia and New Zealand showed that the overall rate of EONBM was 0.41/1000 in 1992 and 0.06 in 2001. Another report from the US army hospitals showed that from 169,847 babies who were born over 5 years only 42 babies had EONM, 66% of them were symptomatic prior to the LP. In view of the very low risk of EONM do we need to do LP for every term newborn with adverse obstetric factors and 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 <772 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.

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