Traumatic Lumbar Punctures in Neonates

Greenberg, Rachel G.; Smith, Patrick B.; Cotten, C. Michael; Moody, M. Anthony; Clark, Reese H.; Benjamin, Daniel K.

doi:10.1097/inf.0b013e31817e519b

Cited by 101 publications

(46 citation statements)

References 21 publications

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“…Prior studies have investigated methods of correcting CSF WBC for the presence of CSF RBCs in children with a traumatic LP. 4,11,12,14 Heterogeneity of patient populations, varying traumatic LP definitions and changes in bacterial meningitis epidemiology due to widespread conjugate vaccination limit the applicability to our study population. 23 The largest study to date included 2519 infants < 30 days of age in the neonatal intensive care unit.…”

Section: Discussionmentioning

confidence: 99%

“…the regression-based correction factor 3) a 1000:1 CSF RBCs:CSF WBCs correction factor, 4) a 500:1 CSF RBCs:CSF WBCs correction factor and 5) an correction factor based on using the peripheral RBC to WBC ratio [CSF WBC corrected = CSF WBC – (CSF RBC × Peripheral WBC/Peripheral RBC)]. 4 The area under the curve (AUC) for the receiver operator characteristic curve was determined for each of these five strategies using CSF WBC count as a continuous variable. For purposes of comparison, we assessed the ability the CSF WBC count to detect bacterial meningitis in infants with a non-traumatic LP.…”

Section: Methodsmentioning

confidence: 99%

“…2,6,7 Although several methods for correction of the CSF white blood cell (WBC) count for the presence of red blood cells (RBCs) have been investigated, 8–14 these approaches have not been extensively evaluated in the youngest infants and remain controversial. 4,10 …”

Section: Introductionmentioning

confidence: 99%

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Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture

Lyons

Cruz

Freedman

et al. 2017

Annals of Emergency Medicine

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Study Objective To determine the optimal correction factor for cerebrospinal fluid (CSF) white blood cell (WBC) counts in infants with traumatic lumbar punctures (LPs). Methods We performed a secondary analysis of a retrospective cohort of infants ≤ 60–days-old with a traumatic LP [CSF red blood cell (RBC) count ≥ 10,000 cells/mm3] at 20 participating centers. CSF pleocytosis was defined as a CSF WBC count ≥ 20 cells/mm3 for infants ≤ 28 days, ≥ 10 cells/mm3 for infants 29–60 day and bacterial meningitis as growth of pathogenic bacteria from CSF culture. Using linear regression, we derived a CSF WBC correction factor and compared the uncorrected to the corrected CSF WBC count for the detection of bacterial meningitis. Results Of the eligible 20,319 LPs, 2,880 (14%) were traumatic of whom 33 (1.1%) had bacterial meningitis. The derived CSF RBCs:WBCs ratio was 877:1 [95% confidence interval (CI) 805–961:1]. Compared with the uncorrected CSF WBC count, the corrected CSF WBC count had lower sensitivity for bacterial meningitis [88% uncorrected vs. 67% corrected; difference 21%, 95% CI 10–37%] but resulted in fewer infants with CSF pleocytosis [78% uncorrected vs. 33% corrected; difference 45%, 95% CI 43–47%]. CSF WBC count correction resulted in 7 additional infants with bacterial meningitis being misclassified as not having CSF pleocytosis; only one of these infants was > 28-days-old. Conclusion Correction of the CSF WBC count substantially reduced the number of infants with CSF pleocytosis while misclassifying only one infant with bacterial meningitis 29 to 60 days of age.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture

Lyons

Cruz

Freedman

et al. 2017

Annals of Emergency Medicine

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“…CSF pleocytosis was defined as ≥20 cells/mm 3 for ≤28 day-olds and ≥10 cells/mm 3 for 29–89 day-olds based on data from large studies [18], [19] with no adjustment made for traumatic taps [20].…”

Section: Preamblementioning

confidence: 99%

Neonatal infections: Case definition and guidelines for data collection, analysis, and presentation of immunisation safety data

Vergnano

Buttery

Cailes

et al. 2016

Vaccine

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Maternal vaccination is an important area of research and requires appropriate and internationally comparable definitions and safety standards. The GAIA group, part of the Brighton Collaboration was created with the mandate of proposing standardised definitions applicable to maternal vaccine research. This study proposes international definitions for neonatal infections.The neonatal infections GAIA working group performed a literature review using Medline, EMBASE and the Cochrane collaboration and collected definitions in use in neonatal and public health networks. The common criteria derived from the extensive search formed the basis for a consensus process that resulted in three separate definitions for neonatal blood stream infections (BSI), meningitis and lower respiratory tract infections (LRTI). For each definition three levels of evidence are proposed to ensure the applicability of the definitions to different settings.Recommendations about data collection, analysis and presentation are presented and harmonized with the Brighton Collaboration and GAIA format and other existing international standards for study reporting.

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“…Higher cell counts are usually associated with Gram-negative versus Gram-positive meningitis (179). While the red blood cell (RBC) level considered to represent a "traumatic" tap in CSF for patients with suspected meningitis has ranged from Ͼ500 cells/mm 3 to Ͼ1,000 cells/mm 3 (180,181), there has been no proven diagnostic benefit in adjusting the CSF WBC count for the number of red blood cells (182). Furthermore, the number of immature white cells, such as bands in the CSF, is not predictive of meningitis.…”

Section: Csf Parameters In Suspected Neonatal Meningitismentioning

confidence: 99%

Early-Onset Neonatal Sepsis

et al. 2014

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SUMMARY Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.

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Traumatic Lumbar Punctures in Neonates

Cited by 101 publications

References 21 publications

Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture

Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture

Neonatal infections: Case definition and guidelines for data collection, analysis, and presentation of immunisation safety data

Early-Onset Neonatal Sepsis

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