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Evaluation of febrile infants under 3 months of age: is routine lumbar puncture warranted?
Isr J Med Sci. 1997 Feb; 33(2):93-7.IJ

Abstract

Fever may be the sole clinically evident presentation of serious bacterial infection (SBI) in a very young infant, and therefore lumbar puncture is still widely regarded as a mandatory procedure in the sepsis workup of febrile infants under 2 months of age. In this retrospective study, we evaluated the frequency and the diagnostic value of cerebrospinal fluid examination in 492 infants aged less than 3 months who were hospitalized because of fever during 1988-1994. The patients were categorized as being at "high risk" or "low risk" for SBI according to current clinical and laboratory criteria. Among the 492 infants, 196 (40%) were identified as "high-risk" for SBI, and 296 (60%) were at low risk. Among the overall series of infants, 60 babies (12%) were subsequently proven with bacterial infection. Among the 196 "high-risk" babies, 26% had bacterial infection, compared to only 3% of the 296 infants at low risk (p < 0.0001), denoting a sensitivity of 85% and a specificity of 65% of the clinical classification criteria. Lumbar puncture was done to 186 (46%) infants upon hospital admission; 176 punctures yielded satisfactory samples of cerebrospinal fluid (CSF). Sixteen (3%) patients had abnormal CSF findings: 2 of them had positive bacterial cultures and 14 were compatible with aseptic meningitis. The 2 patients with purulent meningitis were clinically very ill and were immediately recognized as deserving a lumbar puncture. Of the 14 patients with aseptic meningitis, 13 were initially screened as being at high risk for serious infection, and therefore underwent a lumbar puncture. Over the years of this survey, a declining trend for performing lumbar puncture in "low-risk" young febrile infants became evident: during 1988-1992, evaluation of sepsis included a lumbar puncture in 45% of the infants, compared to 27% during the following 2 years (p < 0.0001). Not one instance of purulent meningitis evolved among the infants in whom lumbar puncture was not performed. Our observations suggest that hospitalized young febrile infants may safely be spared a lumbar puncture when they do not meet the proposed criteria for being at high risk, or when their clinical and laboratory picture suggests being at low risk for SBI.

Authors+Show Affiliations

Department of Pediatrics, Rambam Medical Center, Haifa, Israel.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9254869

Citation

Brik, R, et al. "Evaluation of Febrile Infants Under 3 Months of Age: Is Routine Lumbar Puncture Warranted?" Israel Journal of Medical Sciences, vol. 33, no. 2, 1997, pp. 93-7.
Brik R, Hamissah R, Shehada N, et al. Evaluation of febrile infants under 3 months of age: is routine lumbar puncture warranted? Isr J Med Sci. 1997;33(2):93-7.
Brik, R., Hamissah, R., Shehada, N., & Berant, M. (1997). Evaluation of febrile infants under 3 months of age: is routine lumbar puncture warranted? Israel Journal of Medical Sciences, 33(2), 93-7.
Brik R, et al. Evaluation of Febrile Infants Under 3 Months of Age: Is Routine Lumbar Puncture Warranted. Isr J Med Sci. 1997;33(2):93-7. PubMed PMID: 9254869.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of febrile infants under 3 months of age: is routine lumbar puncture warranted? AU - Brik,R, AU - Hamissah,R, AU - Shehada,N, AU - Berant,M, PY - 1997/2/1/pubmed PY - 1997/2/1/medline PY - 1997/2/1/entrez SP - 93 EP - 7 JF - Israel journal of medical sciences JO - Isr J Med Sci VL - 33 IS - 2 N2 - Fever may be the sole clinically evident presentation of serious bacterial infection (SBI) in a very young infant, and therefore lumbar puncture is still widely regarded as a mandatory procedure in the sepsis workup of febrile infants under 2 months of age. In this retrospective study, we evaluated the frequency and the diagnostic value of cerebrospinal fluid examination in 492 infants aged less than 3 months who were hospitalized because of fever during 1988-1994. The patients were categorized as being at "high risk" or "low risk" for SBI according to current clinical and laboratory criteria. Among the 492 infants, 196 (40%) were identified as "high-risk" for SBI, and 296 (60%) were at low risk. Among the overall series of infants, 60 babies (12%) were subsequently proven with bacterial infection. Among the 196 "high-risk" babies, 26% had bacterial infection, compared to only 3% of the 296 infants at low risk (p < 0.0001), denoting a sensitivity of 85% and a specificity of 65% of the clinical classification criteria. Lumbar puncture was done to 186 (46%) infants upon hospital admission; 176 punctures yielded satisfactory samples of cerebrospinal fluid (CSF). Sixteen (3%) patients had abnormal CSF findings: 2 of them had positive bacterial cultures and 14 were compatible with aseptic meningitis. The 2 patients with purulent meningitis were clinically very ill and were immediately recognized as deserving a lumbar puncture. Of the 14 patients with aseptic meningitis, 13 were initially screened as being at high risk for serious infection, and therefore underwent a lumbar puncture. Over the years of this survey, a declining trend for performing lumbar puncture in "low-risk" young febrile infants became evident: during 1988-1992, evaluation of sepsis included a lumbar puncture in 45% of the infants, compared to 27% during the following 2 years (p < 0.0001). Not one instance of purulent meningitis evolved among the infants in whom lumbar puncture was not performed. Our observations suggest that hospitalized young febrile infants may safely be spared a lumbar puncture when they do not meet the proposed criteria for being at high risk, or when their clinical and laboratory picture suggests being at low risk for SBI. SN - 0021-2180 UR - https://www.unboundmedicine.com/medline/citation/9254869/Evaluation_of_febrile_infants_under_3_months_of_age:_is_routine_lumbar_puncture_warranted L2 - https://medlineplus.gov/fever.html DB - PRIME DP - Unbound Medicine ER -