OBJECTIVE: We performed this investigation to assess whether selective approaches to performing lumbar puncture (LP) in the early neonatal period will result in a missed or delayed diagnosis of bacterial meningitis. DESIGN: A retrospective review was conducted of the medical records of all neonates born in US Army hospitals from 1988 through 1992 who developed culture-positive meningitis during the first 72 hours of life. RESULTS: In total, 169,849 infants were born during the 5-year study period. The incidence of meningitis in the first 72 hours of life was 0.25 per 1000 live births. Forty-three infants had organisms isolated from their cerebrospinal fluid (30, group B streptococcus; 10, Escherichia coli; 1, Listeria monocytogenes; 1, Streptococcus pneumoniae; and 1, Citrobacter diversus). The median age of infants at evaluation was 12 hours, and the mean gestational age was 38.8 weeks (7 < 37 weeks), whereas mean birth weight was 3163 g (7 < 2500 g). If we had used currently advocated selective criteria as the basis for not performing an LP, the diagnosis of bacterial meningitis would have been missed or delayed in 16 of 43 infants (37%): 5 infants born prematurely with suspected respiratory distress syndrome, 3 asymptomatic infants born at term with positive blood cultures, and 8 infants born at term with no central nervous system symptoms and negative blood cultures. CONCLUSIONS: If LPs are omitted as part of the early neonatal sepsis evaluation, the diagnosis of bacterial meningitis occasionally will be delayed or missed completely.
OBJECTIVE: We performed this investigation to assess whether selective approaches to performing lumbar puncture (LP) in the early neonatal period will result in a missed or delayed diagnosis of bacterial meningitis. DESIGN: A retrospective review was conducted of the medical records of all neonates born in US Army hospitals from 1988 through 1992 who developed culture-positive meningitis during the first 72 hours of life. RESULTS: In total, 169,849 infants were born during the 5-year study period. The incidence of meningitis in the first 72 hours of life was 0.25 per 1000 live births. Forty-three infants had organisms isolated from their cerebrospinal fluid (30, group B streptococcus; 10, Escherichia coli; 1, Listeria monocytogenes; 1, Streptococcus pneumoniae; and 1, Citrobacter diversus). The median age of infants at evaluation was 12 hours, and the mean gestational age was 38.8 weeks (7 < 37 weeks), whereas mean birth weight was 3163 g (7 < 2500 g). If we had used currently advocated selective criteria as the basis for not performing an LP, the diagnosis of bacterial meningitis would have been missed or delayed in 16 of 43 infants (37%): 5 infants born prematurely with suspected respiratory distress syndrome, 3 asymptomatic infants born at term with positive blood cultures, and 8 infants born at term with no central nervous system symptoms and negative blood cultures. CONCLUSIONS: If LPs are omitted as part of the early neonatal sepsis evaluation, the diagnosis of bacterial meningitis occasionally will be delayed or missed completely.
Authors: Roberto Romero; Piya Chaemsaithong; Nikolina Docheva; Steven J Korzeniewski; Juan P Kusanovic; Bo Hyun Yoon; Jung-Sun Kim; Noppadol Chaiyasit; Ahmed I Ahmed; Faisal Qureshi; Suzanne M Jacques; Chong Jai Kim; Sonia S Hassan; Tinnakorn Chaiworapongsa; Lami Yeo; Yeon Mee Kim Journal: J Perinat Med Date: 2016-01 Impact factor: 1.901
Authors: Annette K Ansong; P Brian Smith; Daniel K Benjamin; Reese H Clark; Jennifer S Li; C Michael Cotten; Barry Mangum; Harmony P Garges; Daniel K Benjamin Journal: Early Hum Dev Date: 2009-09-19 Impact factor: 2.079
Authors: Alonso Zea-Vera; Christie Gloria Turín; María Susana Rueda; Daniel Guillén-Pinto; Pilar Medina-Alva; Aldredo Tori; María Rivas; Jaime Zegarra; Anne Castañeda; Luis Cam; Theresa J Ochoa Journal: Rev Peru Med Exp Salud Publica Date: 2016-06
Authors: P Brian Smith; Harmony P Garges; C Michael Cotton; Thomas J Walsh; Reese H Clark; Daniel K Benjamin Journal: Am J Perinatol Date: 2008-08-22 Impact factor: 1.862