Meningitis in premature infants with respiratory distress: Role of admission lumbar puncture

Weiss, M; Ionides, S. P.; Anderson, Craig L.

doi:10.1016/s0022-3476(05)83059-8

Cited by 52 publications

(23 citation statements)

References 11 publications

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“…The data on whether CSF pleocytosis or abnormal glucose or protein levels were present are also not provided. Given that we found a ratio of CSF contaminants to pathogens of 3:1, and Weiss et al 5 found a ratio of 4.7:1 in premature infants, it is pos- sible that some of the isolates of Wiswell et al 9 were contaminants. Organisms that can be pathogenic were shown to be contaminants by second LP, including Enterobacter, Streptococcus mitis, and S aureus.…”

Section: Discussionmentioning

confidence: 54%

“…They concluded that LP is not indicated in asymptomatic full-term or preterm infants born to high-risk mothers. In the study of Weiss et al, 5 2156 premature infants with respiratory distress had 1495 successful LPs at admission. A rate of early-onset meningitis of 0.27% was found, and a contamination rate of 1.3% was found.…”

Section: Discussionmentioning

confidence: 99%

“…GBS sepsis has a high incidence of coexistent meningitis; therefore, an LP to exclude the possibility of meningitis has traditionally been included in the evaluation of newborns born to GBS-colonized women who have fever or prolonged rupture of membranes, although previous studies have been in mixed preterm and full-term infants, [5][6][7] whereas ours was exclusively in full-term newborns. In our study, 3423 LPs were done in asymptomatic full-term infants, of which none revealed meningitis, but 35 had contaminants (0.96%).…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Lumbar puncture (LP) is often performed immediately after delivery in asymptomatic newborns after chemoprophylaxis as part of a sepsis evaluation to diagnose bacterial meningitis. However, the studies evaluating the clinical usefulness of LP have been done primarily in preterm infants [5][6][7] or in neonatal intensive care units with both full-term and preterm infants. 8 -10 It may not be appropriate to generalize the findings from high-risk populations to asymptomatic full-term infants cared for in general nurseries.…”

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confidence: 99%

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Term Newborns Who Are at Risk for Sepsis: Are Lumbar Punctures Necessary?

et al. 1997

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ABSTRACT. Objectives. To determine: (1) whether a lumbar puncture (LP) is indicated in asymptomatic fullterm newborns delivered by mothers at risk of intrapartum sepsis; and (2) whether gentamicin improves bacterial coverage for such newborns when used with ampicillin.Design. A retrospective chart review from 1987 through 1993 of all newborns with positive blood and/or cerebrospinal fluid cultures in the first 7 days of life.Methods. Pregnant women were screened in the second trimester for group B streptococci and given ampicillin during labor if two or more risk factors were present: group B streptococci colonization, maternal fever or leukocytosis, rupture of membranes at more than 18 hours, foul-smelling amniotic fluid, and fetal tachycardia. After sepsis evaluation (LP, blood culture, white blood cell count, and differential), asymptomatic infants received ampicillin and gentamicin for 48 to 72 hours unless cultures grew pathogens.Results. Of approximately 24 452 full-term births in 7 years, 7% (1712) had evaluations for symptoms of sepsis, and 14% (3423) were asymptomatic but had evaluations for maternal risk factors. There were 11 cases of meningitis, all involving symptomatic newborns; 10 of these 11 had positive blood cultures for the same organism. In asymptomatic infants, none of the 3423 had meningitis (95% confidence interval, 0 to 0.0008), although 35 grew contaminants. Of 73 pathogens isolated from blood or cerebrospinal fluid, 7 (9.5%) were resistant to ampicillin. Addition of gentamicin provided coverage for only 2 of these 7 pathogens. Of 5135 infants who received ampicillin and gentamicin, only 2 required gentamicin for improved coverage.Conclusions.(1) LP is unnecessary in asymptomatic full-term newborns. (2) Empiric coverage for asymptomatic newborns with maternal risk factors need not include gentamicin at all hospitals, because it only improved the coverage of ampicillin alone from 90% to 93% of pathogens, but it exposed more than 5000 infants to the side effects of gentamicin. (3) The presence of leukopenia (<5000 white blood cells/mm 3 ) is highly predictive of bacteremia. Pediatrics 1997;99(4). URL: http://www. pediatrics.org/cgi/content/full/99/4/e10; newborn, lumbar puncture, meningitis.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Term Newborns Who Are at Risk for Sepsis: Are Lumbar Punctures Necessary?

et al. 1997

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“…There are no data in preterm infants examining trends in CSF pleocytosis after antibiotics have been administered. Some clinicians do not routinely perform lumbar puncture in preterm infants with suspected sepsis unless there is growth of an organism on blood culture (142,497). Since meningitis may occur without septicemia and since blood cultures may be falsely negative, this places VLBW infants at risk of being undertreated for meningitis (454a).…”

Section: Definitions Of Sepsis and Focal Infections In Very-low-birthmentioning

confidence: 99%

Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

2004

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Twenty percent of very-low-birth-weight (<1500 g) preterm infants experience a serious systemic infection, and despite advances in neonatal intensive care and antimicrobials, mortality is as much as threefold higher for these infants who develop sepsis than their counterparts without sepsis during their hospitalization. Outcomes may be improved by preventative strategies, earlier and accurate diagnosis, and adjunct therapies to combat infection and protect the vulnerable preterm infant during an infection. Earlier diagnosis on the basis of factors such as abnormal heart rate characteristics may offer the ability to initiate treatment prior to the onset of clinical symptoms. Molecular and adjunctive diagnostics may also aid in diagnosing invasive infection when clinical symptoms indicate infection but no organisms are isolated in culture. Due to the high morbidity and mortality, preventative and adjunctive therapies are needed. Prophylaxis has been effective in preventing early-onset group B streptococcal sepsis and late-onset Candida sepsis. Future research in prophylaxis using active and passive immunization strategies offers prevention without the risk of resistance to antimicrobials. Identification of the differences in neonatal intensive care units with low and high infection rates and implementation of infection control measures remain paramount in each neonatal intensive care unit caring for preterm infants

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