Should inflammatory markers inform the decision to perform a lumbar puncture in infants with suspected neonatal sepsis?.

Blackwell Publishing 2015-05-13

Background: Meningitis frequently complicates neonatal sepsis, but there is little consistency to when to perform a lumbar puncture (LP). We investigated whether inflammatory markers; C-reactive protein (CRP) and immature-to-total neutrophil ratio (ITR) were predictive of meningitis or significant CSF pleocytosis and could guide the decision to perform a LP. Method(s): We studied all level 3 NICU inpatients <6 months old with a LP performed between March 2011 and October 2014; categorised on the basis of CSF results as follows: 1) culture-confirmed meningitis, 2) possible meningitis (CSF culture negative plus CSF leukocyte criteria; (i) CSF WCC>100, (ii) WCC > 20 and <500 RBC, (iii) OE ratio > 10), and 3) no evidence of meningitis. CRP and ITR obtained within 48 hours of LP were retrieved. Area under ROC curves were used to determine the test performance of CRP and ITR in predicting meningitis. Result(s): 1193 CSF samples from 801 individual infants yielded 13 cases of culture positive meningitis, 89 possible meningitis, and 837 nonmeningitis. The area under ROC curve for confirmed and possible meningitis: CRP 0.44 (95% CI 0.38-0.51), ITR 0.57 (95% CI 0.51-0.63). At a CRP threshold of 30 mg/L, there was a positive likelihood ratio (LR) of 0.7, and a negative LR of 1.4. Conclusion(s): The test performances of CRP and ITR for differentiating confirmed and possible meningitis were poor, and therefore inflammatory markers should not inform the decision to perform a LP.

infant; meningitis; cerebrospinal fluid; receiver operating characteristic; task performance; leukocyte; neutrophil; cerebrospinal fluid culture; human; pleocytosis; hospital patient; erythrocyte; marker; C reactive protein; society; newborn sepsis; Australia and New Zealand; lumbar puncture; Conference Abstract

AUSHL oai:repository.monashhealth.org:1/41481
Journal of Paediatrics and Child Health. Conference: 19th Annual Meeting of the Perinatal Society of Australia and New Zealand, PSANZ 2015. Melbourne, VIC Australia. Conference Publication: (var.pagings). 51 (SUPPL. 1) (pp 84), 2015. Date of Publication: April 2015.
1034-4810
https://repository.monashhealth.org/monashhealthjspui/handle/1/41481
71874005
(Goldfinch, Tan) Monash Newborn, Australia (Korman, Kotsanas) Dept Infect Diseases, Monash Health, Australia (Burgner) Paed Infect Diseases, Monash Children's Hospital, Australia (Burgner) Murdoch Children's Research Inst, Australia (Burgner, Tan) Dept of Paediatrics, Monash University, Australia (Tan) Ritchie Centre, PHI-MIMR, Australia
Tan K.; Kenneth.tan@monash.edu
(Goldfinch, Tan) Monash Newborn, Australia
(Burgner) Murdoch Children's Research Inst, Australia
(Burgner, Tan) Dept of Paediatrics, Monash University, Australia
(Tan) Ritchie Centre, PHI-MIMR, Australia
(Korman, Kotsanas) Dept Infect Diseases, Monash Health, Australia
(Burgner) Paed Infect Diseases, Monash Children's Hospital, Australia
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