Importance of obtaining lumbar puncture in neonates with late onset septicemia a hospital based observational study from north-west India

Abstract

Objectives:The objective of this study was to estimate the prevalence of meningitis in cases with late onset septicemia (LOS).Materials and Methods:A prospective study was carried out for a period of 1 year in a tertiary care hospital in North West India to estimate the prevalence of meningitis in cases of LOS. In all the admitted neonates with features of sepsis with a positive C-reactive protein, a lumbar puncture (LP) was carried out and results interpreted on the basis of cerebrospinal fluid (CSF) cytology and biochemistry. Simultaneous blood and CSF cultures were also taken. All other baseline investigations were performed and in those diagnosed as meningitis an ultrasound head was carried out prior to discharge. No urine cultures were obtained.Results:The study showed the prevalence of meningitis as 22.5% in neonates with LOS with statistically significant implications of meningitis versus gestation, sex, acquired the place of infection, and outcome in terms of sequelae/mortality.Conclusions:Meningitis is commonly associated with late onset sepsis hence LP should be the standard of care in such neonates as the treatment protocol and the outcome is directly proportional to the diagnosis at initial presentation.

Bacterial aetiology of neonatal meningitis: A study from north-east India

“…Similar observation has been made earlier from India6. In the present study, only 12 per cent cases showed increased CSF protein and 7.5 per cent showed decreased glucose.…”

“…In our study, 68.6 per cent neonates with microbiologically proven meningitis were males; and 54 per cent were of low birth weight (LBW), 11 per cent were very LBW and 28 per cent were pre-term. Kaul et al 6 have also observed high frequency of meningitis and sepsis among LBW neonates. A. baumannii , Klebsiella , CoNS and Enterococcus were common bacterial isolates in our study similar to other studies from India 4 15 .…”

“…It has been reported that neonatal meningitis can occur in the absence of bacteraemia and no single cerebrospinal fluid (CSF) value can exclude its presence 3 . Several studies from India have reported the spectrum of bacterial pathogens and the existence of antibiotic resistance among the isolates from neonatal sepsis/meningitis cases 4 5 6 7 . We have earlier isolated rarely encountered bacteria including Neisseria meningitidis serogroup Y 8 , Sneathia 9 and Globicatella (unpublished) species from CSF of neonates from north-east India.…”

Role of neonatal cerebrospinal fluid cytology in correlation to C-reactive protein, blood culture, risk factors and clinical outcomes in neonatal intensive care

“…Around 22% prevalence of meningitis is seen in cases of late-onset sepsis, though the incidence of meningitis in neonatal sepsis is 0.3%–3%. [ 21 ] In this study also, the preterm neonates and those with a risk factor including chorioamnionitis or abscess have shown coexistence of meningitis. The CSF cytology and cell count, CSF neutrophils, blood neutrophil percentage, and CRP showed to have a good correlation with meningitis in this study, particularly in the appropriate clinical setting.…”

Frequency of Meningitis in Neonatal Sepsis

“…Neonatal meningitis has been linked to a 33-48 % mortality rate in developing countries while these estimates are around 10% in developed countries (6) . According to earlier studies meningitis affects about 0.3-3 percent of neonates with sepsis, while the incidence of meningitis in neonates with LOS is much greater, reaching up to 30 percent (11,17) . According to Roshi et.al.…”