NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
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Summary of New
Neonatal Management
2.
Indications for Lumbar
Puncture as part of a neonatal sepsis evaluation.
Ø
Designates change or
addition to 1996 CDC guidelines.
ü
Designates reiteration of
1996 CDC guidelines.
ü
A lumbar puncture should be done as part of the sepsis work up
in all infants with clinical signs
suggesting possible sepsis, if feasible.
Ø
If a lumbar puncture has been deferred for a neonate receiving
empiric antibiotic therapy, and the therapy is continued more than 48 hours
because of suspected infection, then cerebrospinal fluid should be obtained
for routine studies and culture.
Suggested Discussion Points:
1.
Do these recommendations regarding lumbar puncture apply only to
infants who received intrapartum antibiotic prophylaxis for GBS, or should
they be generalized to all neonates being evaluated and treated for suspected
sepsis?
2.
Do neonates with mild signs or symptoms (hypoglycemia, tachypnea,
temperature instability, poor nippling) really require a spinal tap as part of
their sepsis evaluation?
Comments:
The increased emphasis on
lumbar punctures as part of the sepsis evaluation is made because up to 15% of
infants with meningitis can have negative blood cultures.
The requirement for doing a spinal tap will make us think twice before
deciding to continue antibiotics > 48 hours if cultures are negative.
ABK
Additional Comments:
Date: 17 Dec 2002
Time: 18:59:15
If an infant is being treated for pulmonary infiltrates for greater then 48
hours is it feasible to do a lumbar puncture?
UserName: Donna Baranek NNP
Institution: Stony Brook University Hospital, Stony Brook, N.Y.
telephone: 631 444 2001
email: baranek@optonline.net
Date: 19 Dec 2002
Time: 14:04:15
Yes, I think most would agree that it's "feasible" to do an LP in
such a baby .... but is it Necessary?? The consensus of the CDC panel of
experts was YES! If your suspicion of possible sepsis or pneumonia is
significant enough that you are not comfortable discontinuing antibiotics after
48 hours of negative cultures, then an LP should be done to rule out a concomitant
meningitis.
Andy Kairalla MD
Editor
Date: 24 Aug 2005
Time: 15:17:42
Other studies, such as serial C-reactive proteins may help guide whether an LP is indicated. In the Neoreviews.org article "Neonatal Meningitis in the New Millenium" by Alistair Philip, MD, Vol. 4 No.3, March 2003, he states that "the CRP rises reliably within 24-48 hours in cases of meningitis, sometimes to very high levels...meningitis is virtually eliminated if the CRP level remains normal. However, if the CRP increases substantially (>4 mg/dL), LP should always be performed. Peak levels of CRP are frequently in excess of 10 mg/dL and almost always greater than 7 mg/dL with neonatal bacterial meningitis." Be aware that some hospitals report CRPs in mg/L (4 mg/dL = 40 mg/L).
UserName: Mary T. Newport, M.D.
Institution: Spring Hill Regional Hospital
telephone: 352-666-6378
email:
preemiedoctor@aol.com or
NAMDPA@aol.com
Date: 16 Sep 2005
Time: 22:46:53
Do you postpone L.P for thrombocytopenia or you prefer to give platlets before
L.P
UserName: Ibrahim
Institution: HSC,winnipeg.Manitoba
telephone: 204 237 8651
email: ihakim2000@hotmail.com
Date: 07 Oct 2005
Time: 10:00:33
Reader asked question about thrombocytopenia and LPs. The definition is key,
but LP is still a low risk procedure even in the face of low platelet
counts, assuming of course one feels the infant is otherwise stable enough
to get stuck. Diagnostic and therapeutic LPs in pediatric cancer patients
are routinely done @ >=50K and that's the level I would use for a neonate.
UserName: Mark H. Croley, M.D.
Institution: Wilford Hall USAF Medical Center
telephone: 210-292-6679
email:
mark.croley@lackland.af.mil
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