Neonatal sepsis: The role of lumbar punctures.

 
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Carse C*, Paladugu M**
Department of Neonatology, Royal Preston Hospital.*, Department of Neonatology, Royal Preston Hospital.**
Background
Recent literature suggests NICE CG149 has led to unnecessary lumbar punctures when investigating septic neonates. We investigated the of role lumbar punctures in the management of neonatal sepsis at Royal Preston Hospital.
Methods
Lumbar puncture results were collected retrospectively by microbiology from March 2014- March 2015. Duplicates, non-septic cases and those without corresponding patient notes were removed (n = 33). Patient notes (n = 104) were analysed for clinical history, discussions and subsequent outcomes.
Results
The decision to carry out a lumbar puncture was due to an initial high CRP or an increase in CRP in 75% of the cohort. Results suggest an informal CRP threshold of 20. Of all lumbar punctures, 56.7% were traumatic vs. 35-45% reported in literature. Correction factors and a CSF white cell count threshold of 15 cell/mm3 was used to identify neonates at risk of meningitis; of 22 cases only two were coded as meningitis, and 19 were treated with less than the 14 days of antibiotics. Increased duration of treatment was associated with white cell count and CRP.
Conclusion
The overarching narrative of this audit is that whilst doctors on the unit are recognising most of the neonates at risk of meningitis, they are not being treated in compliance with NICE guidelines. Recommendations include a review of local guidelines to standardise investigation and treatment, a trial of PCR assays in diagnosis of bacterial and viral meningitis as well as improved documentation. Future plans include an audit of lumbar puncture procedure and compliance with indications for lumbar punctures in the wider septic population, as well as a survey of regional unit’s CSF infection parameters and treatment regimes.
 
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C C, M P.. Available From : http://www.pediatriconcall.com/conference/abstract/35/view/842
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