Is lumbar puncture necessary in a high risk for sepsis,clinically well term newborn ?

My practise, lumbar puncture in suspected sepsis with crp>100, to ensure that there is no meningitis.

If there are signs of meningitis, this is most likely to prolong the course of antibitiocs (as compared to sepsis without meningitis.)

lumbar puncture is necessary in gram negative sepsisbut If there are signs of meningitis

and sign of increase intra cranial tension , CT Scan is needed

Thanks colleagues for your help.

This is about a one day old newborn, product of a septic mother with high fever,and respiratory faillure.Deliver by C section at 37 weeks. No reanimation required.Baby looks well.Some residents ask about LP as part of the sepsis work up.

We do LP in all infants with positive cultures.And in all with fever or meningeal signs. But in a term,looking well baby...Should we wait ????

If you suspect sepsis in a newborn always do LP unless there is a contraindication (like thrombocytopenia or moribund condition). LP should not be deferred till after a positive blood culture result. If you wait for a positive blood culture, you might miss doing LP in culture negative clinical sepsis or may never get any organism in a CSF as the baby has already got few days of antibiotics.

...This is about a one day old newborn, product of a septic mother with high fever,and respiratory faillure.Deliver by C section at 37 weeks. No reanimation required.Baby looks well....

In this case it seems that the baby is only at risk for sepsis but is not showing any overt signs/symptoms of sepsis. In this case I might wait for the CBC and Blood c/s results before I think of a LP unless of course the baby shows any symptoms/signs

Thanks Jack,I agree with you .Best regards. Leonora

lumbar puncture in newborns with suspected sepsis has been a bone of contention with us, but in a stable well new born LP may not necessary unless the culture is positive, suspected sepsis in one week old newborn,( late sepsis) yes the LP is a part of sepsis work.

Case update.The baby stay clinically well. Blood culture and CRP negative.CBC normal.

Mom OK too. Both at home now. Thanks all , friends.!!!

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There is considerable difference of opinion amongst clinicians and in literature whether CSF should be examined every time a ‘sepsis work-up’ is performed. Due to low rate of meningitis (1% of over 9000 blood culture positive infants [Harmony P et al 2006]) many authors do not recommend routine lumbar puncture in the absence of a positive blood culture or localizing findings [Wiswell T 1995, MacMohan P 1990]. Current opinion varies from including CSF examination in every ‘work-up’, to examining the CSF when there are clinical features of meningitis or examining the CSF only when there is a positive blood culture. Data however suggests that as many as 38% of culture-positive meningitis in neonates had negative blood culture taken at the same time! [Harmony P 2006]. This may have to do with the problems associated with blood culture as enumerated earlier rather than true dichotomy between blood and CSF culture positivity rates. Never the less meningitis can only be diagnosed or excluded if CSF is examined!

We would always do an LP for LOS but defer to clinical history and condition of the baby for doing an LP for EOS.

some times it happens, but i am agree with the "work up sepsis"

Always check clotting studies prior to LP, have worked in a unit with undiagnosed congenital haemophillia, LP resulted in massive blood clot within the spinal cord and serious short term consequences, not sure re long term.