PS-307National Recommendations For The Investigation Of Early Onset Neonatal Sepsis: Lumbar Puncture Incidence And Indications

• Published in: Archives of disease in childhood Vol. 99; no. Suppl 2; p. A222
• Main Authors: Irving, R, Lister, P, Jolley, D, Hamilton, L F, Gillet, HE, Davis, J W
• Format: Journal Article
• Language: English
• Published: 01.10.2014
• ISSN: 0003-9888
• DOI: 10.1136/archdischild-2014-307384.606

BackgroundEarly onset sepsis (EOS) is a leading cause of morbidity and mortality in newborns. The incidence of culture-positive EOS in UK neonates is 0.9/1000 live births. We aimed to compare EOS investigation practice with The National Institute of Clinical Excellence (NICE) guidelines (2012) for investigation, and determine factors that influence LP acquisition.MethodWe conducted a retrospective observational study in a regional neonatal unit, using data from 213 babies investigated for EOS (< 48 h). We reviewed patient notes, electronic records, and pathology results in 2 epochs (September-October 2012, April-May 2013). Clinical concern of infection was judged retrospectively using NICE criteria (any 'Red Flag', >2 risk factors, or other clinical indicators).ResultsData was collected from 213 term babies (228 infection episodes). Clinical concern for infection was identified in 52/228. These infants had more respiratory distress and shock than those without clinical concern. (p < 0.05). In total 31/228 babies had an LP; 14/31 infants had clinical concern of infection. Clinical concern for infection was similar in the 'LP group' and 'non-LP group'. The 'LP group' had a larger proportion of maternal pyrexia (18/31 vs. 60/137, p < 0.05) and median maximum CRP (19 mg/l vs. 1 mg/l, p < 0.05) than the 'non-LP group'. There were no positive blood/CSF cultures.ConclusionDespite its low incidence EOS causes substantial clinical concern. LPs were not carried out in a number of infants despite meeting NICE criteria. Maternal risk factors and maximum CRP appear to determine the acquisition of LP more than physician 'concern' of infection.