Abstract
BackgroundThere are variations in recommendations from different guidelines regarding the indications for repeat lumbar puncture (LP) in young infants with the diagnosis of bacterial meningitis.ObjectiveTo evaluate the frequency of repeat LPs and the characteristics of cerebrospinal fluid (CSF) parameters in repeated sampling and their predictive values for adverse outcomes in a national cohort.MethodsThis cohort study included infants born January 1, 2013 through December 31, 2014, who had proven or suspected bacterial meningitis within the first 90 days of life at seven paediatric tertiary care hospitals across Canada, and who underwent a repeat LP at the discretion of the treating physicians.ResultsForty-nine of 111 infants (44%) underwent repeat LP at a median of 5 (IQR: 3, 13) days after the LP that led to the diagnosis of bacterial meningitis. Those who had meningitis caused by gram negative bacilli were more likely to have repeat LP than those with gram positive bacteria (77% versus 57%; p = 0.012). White blood cell (WBC) count on the second spinal tap yielded an area under the curve of 0.88 for predicting sequelae of meningitis at discharge from the hospital, with a cut-off value of 366 × 106/L, providing a sensitivity of 91% and specificity of 88%.ConclusionIn this multi-centre retrospective cohort study, infants with gram negative meningitis were more likely to have repeated LP. A high WBC on the second CSF sample was predictive of adverse outcome at the time of discharge from the hospital.
Highlights
Neonatal bacterial meningitis is a life-threatening disease with high rates of mortality and morbidity and leads to substantial long-term neuro-disability [1,2,3]
Forty-nine of 111 infants (44%) underwent repeat lumbar puncture (LP) at a median of 5 (IQR: 3, 13) days after the LP that led to the diagnosis of bacterial meningitis
Those who had meningitis caused by gram negative bacilli were more likely to have repeat LP than those with gram positive bacteria (77% versus 57%; p = 0.012)
Summary
Neonatal bacterial meningitis is a life-threatening disease with high rates of mortality and morbidity and leads to substantial long-term neuro-disability [1,2,3]. Recognition of meningitis and prompt treatment with appropriate antimicrobials is essential in optimizing outcome [4]. Repeat lumbar puncture (LP) during the course of treatment of bacterial meningitis and prolongation of antimicrobials for persistently abnormal cerebrospinal fluid (CSF) parameters have been advocated in young infants [5, 6]. There are variations in the guidelines to specify the indications for repeat LP or interpretation of results [7,8,9,10]. A 2001 survey in the United Kingdom revealed that only 18% of physicians routinely repeated CSFs in neonatal meningitis [11]. There are variations in recommendations from different guidelines regarding the indications for repeat lumbar puncture (LP) in young infants with the diagnosis of bacterial meningitis
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