Meningitis in premature infants with respiratory distress: Role of admission lumbar puncture

Abstract

tress may be the only sign of sepsis, we would prefer to see more data on the yield of CSF examination in infants with respiratory distress before CSF examination is completely discarded, although a selective or delayed approach may be appropriate. Infants with bacteremia who are symptom free may have a sufficient concentration of organisms in the blood to seed the meninges.! ~ Lumbar puncture for sepsis workup of newborn infants currently has a yield of less than 3%. 1, z Therefore it seems appropriate to exclude a group of infants in whom the probability of meningitis is extremely small. In this review we found no cases of meningitis in 284 infants who were symptom free at the time lumbar puncture was performed. Although 284 is not a large number for statistical purposes, it represents only those infants who were examined. The denominator is larger if one includes all symptom-free infants with risk factors who did not undergo lumbar punctures and presumably did not have meningitis. The probability of meningitis in this group is less than 4:1000 and likely to be zero. We conclude that CSF examination is not indicated in the diagnostic evaluation of symptom-free infants born to mothers with chorioamnionitis or other risk factors for neonatal infection.