PC.95 Clinical audit on lumbar punctures performed in a tertiary neonatal unit

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Abstract

Background

Lumbar puncture (LP) is usually performed when there is a clinical suspicion of meningitis in babies with suspected sepsis. NICE recently published their guidelines on ‘antibiotics for early-onset neonatal infections’ with guidance on when LPs should be considered.

Aim

To audit the number of LPs carried out in term babies (>37+0 weeks) in a tertiary neonatal unit, their indications and outcomes.

Methods

A list of term babies who had an LP was obtained from the Microbiology Department between 01/01/2012 and 31/12/2013. The Badger electronic patient record and hospital blood results systems were reviewed to collect the data.

Results

In the last 2 years we had 1,514 distinct term babies admitted to the neonatal unit. 76 babies had an LP during this period. The reasons for LPs were; (a) raised CRP in 61 cases (median CRP was 66), (b) positive blood culture in 6 cases, (c) abnormal neurology in 7 cases, and (d) 2 were for no other clinical focus. There were no positive cultures, although one was positive for herpes simplex virus type 1 on PCR. At discharge, 4 had a diagnosis of meningitis, 1 with encephalitis, 1 with congenital neuropathy. The remainder had a diagnosis of sepsis or suspected sepsis.

Conclusion

The majority of LPs in term babies were performed because of raised CRP. We only had one positive finding on PCR. As per NICE guidance, we rely on a combination of clinical findings and CRPs when deciding which babies to LP.

References

Antibiotics for early-onset neonatal infection - Nice www.nice.org.uk/nicemedia/live/13867/60633/60633.pdf

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