Lumbar Puncture for All Febrile Infants 29-56 Days Old: A Retrospective Cohort Reassessment Study

J Pediatr. 2017 Aug;187:200-205.e1. doi: 10.1016/j.jpeds.2017.04.003. Epub 2017 May 16.


Objectives: To determine the incidence of bacterial meningitis (BM) among all febrile infants 29-56 days old undergoing a lumbar puncture (LP) in the emergency department of a tertiary care children's hospital and the number of low-risk febrile infants with BM to reassess the need for routine LP in these infants.

Study design: Retrospective cohort study using a quality improvement registry from July 2007-April 2014. Infants included were 29-56 days old with fever and who had an LP in the emergency department. Low-risk criteria were adapted from the Philadelphia criteria. BM was defined as having a bacterial pathogen isolated from the cerebrospinal fluid. A medical record review of one-third of randomly selected patients in the cohort determined the proportion who met low-risk criteria.

Results: One of 1188 febrile infants (0.08%) had BM; this patient did not meet low-risk criteria. An additional 40 (3.4%) had positive cerebrospinal fluid cultures; all were contaminants. Subanalysis of one-third of the study population revealed that 45.6% met low-risk criteria; the most common reasons for failing low-risk classification included abnormal white blood cell count or urinalysis.

Conclusions: In a cohort of febrile infants, BM is uncommon and no cases of BM would have been missed had LPs not been performed in those meeting low-risk criteria.

Keywords: febrile infant; lumbar puncture; pediatric emergency department; quality of care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Cohort Studies
  • Emergency Service, Hospital
  • Female
  • Fever / diagnosis*
  • Humans
  • Incidence
  • Infant
  • Male
  • Meningitis, Bacterial / diagnosis
  • Meningitis, Bacterial / epidemiology*
  • Registries
  • Retrospective Studies
  • Spinal Puncture / methods*