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Repeat lumbar punctures in infants with meningitis in the neonatal intensive care unit

Journal of Perinatology volume 31, pages 425–429 (2011)Cite this article

Subjects

Abstract

Objective:

The purpose of this study is to examine the results of repeat lumbar puncture in infants with initial positive cerebrospinal fluid (CSF) cultures in order to determine the clinical characteristics and outcomes of infants with repeat positive cultures.

Study Design:

Cohort study of infants with an initial positive CSF culture undergoing repeat lumbar puncture between 1997 and 2004 at 150 neonatal intensive care units managed by the Pediatrix Medical group. We compared the clinical outcomes of infants with repeat positive cultures and infants with repeat negative cultures.

Result:

We identified 118 infants with repeat CSF cultures. Of these, 26 infants had repeat positive cultures. A higher proportion with repeat positive cultures died compared with those with repeat negative cultures, 6/23 (26%) vs. 6/81 (7%), respectively (P=0.02).

Conclusion:

Among infants with a positive CSF culture, a repeat positive CSF culture is common. The presence of a second positive culture is associated with increased mortality.

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References

  1. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA et al. To tap or not to tap: high likelihood of meningitis without sepsis among very low birth weight infants. Pediatrics 2004; 113 (5): 1181–1186.

    Article  Google Scholar 

  2. Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004; 292 (19): 2357–2365.

    Article  CAS  Google Scholar 

  3. Wenger JD, Hightower AW, Facklam RR, Gaventa S, Broome CV . Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. The Bacterial Meningitis Study Group. J Infect Dis 1990; 162 (6): 1316–1323.

    Article  CAS  Google Scholar 

  4. Klinger G, Chin CN, Beyene J, Perlman M . Predicting the outcome of neonatal bacterial meningitis. Pediatrics 2000; 106 (3): 477–482.

    Article  CAS  Google Scholar 

  5. Durack DT, Spanos A . End-of-treatment spinal tap in bacterial meningitis. Is it worthwhile? JAMA 1982; 248 (1): 75–78.

    Article  CAS  Google Scholar 

  6. Prober CG . Central nervous system infections In: Kliegman R, Nelson WE (eds). Nelson Textbook of Pediatrics. 18th edn. Saunders Elsevier: Philadelphia, 2007, pp lii, 3147 p.

    Google Scholar 

  7. Saez-Llorens X, Mccracken GH . Acute bacterial meningitis beyond the neonatal period. In: Long SS, Pickering LK, Prober CG (eds). Principles and Practice of Pediatric Infectious Diseases. 2nd edn. Churchill Livingstone: New York, 2003, pp xxix, 1645 p.

    Google Scholar 

  8. Klein JO, Feigin RD, McCracken Jr GH . Report of the task force on diagnosis and management of meningitis. Pediatrics 1986; 78 (5 Part 2): 959–982.

    CAS  PubMed  Google Scholar 

  9. Schelonka RL, Freij BJ, Mccracken GH . Bacterial and fungal infections. In: MacDonald MG, Seshia MMK, Mullett MD, Avery GB (eds). Avery's Neonatology: Pathophysiology & Management of the Newborn. 6th edn. Lippincott Williams & Wilkins: Philadelphia, 2005, pp xviii, 1748 p.

    Google Scholar 

  10. Garges HP, Moody MA, Cotten CM, Smith PB, Tiffany KF, Lenfestey R et al. Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters? Pediatrics 2006; 117 (4): 1094–1100.

    Article  Google Scholar 

  11. Thorp JA, Jones PG, Peabody JL, Knox E, Clark RH . Effect of antenatal and postnatal corticosteroid therapy on weight gain and head circumference growth in the nursery. Obstet Gynecol 2002; 99 (1): 109–115.

    CAS  PubMed  Google Scholar 

  12. Custer JW, Rau RE . The Harriet Lane handbook: a manual for pediatric house officers. 2009 [cited]; 18th: (available from: http://www.mdconsult.com/public/book/view?title=The+Harriet+Lane+Handbook).

  13. Walker AM . Confounding by indication. Epidemiology 1996; 7 (4): 335–336.

    CAS  PubMed  Google Scholar 

  14. Signorello LB, McLaughlin JK, Lipworth L, Friis S, Sorensen HT, Blot WJ . Confounding by indication in epidemiologic studies of commonly used analgesics. Am J Ther 2002; 9 (3): 199–205.

    Article  Google Scholar 

  15. Agarwal R, Emmerson AJ . Should repeat lumbar punctures be routinely done in neonates with bacterial meningitis? Results of a survey into clinical practice. Arch Dis Child 2001; 84 (5): 451–452.

    Article  CAS  Google Scholar 

  16. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39 (9): 1267–1284.

    Article  Google Scholar 

  17. Crivaro V, Bagattini M, Salza MF, Raimondi F, Rossano F, Triassi M et al. Risk factors for extended-spectrum beta-lactamase-producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit. J Hosp Infect 2007; 67 (2): 135–141.

    Article  CAS  Google Scholar 

  18. Singh N, Patel KM, Leger MM, Short B, Sprague BM, Kalu N et al. Risk of resistant infections with Enterobacteriaceae in hospitalized neonates. Pediatr Infect Dis J 2002; 21 (11): 1029–1033.

    Article  Google Scholar 

  19. Healy CM, Hulten KG, Palazzi DL, Campbell JR, Baker CJ . Emergence of new strains of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Clin Infect Dis 2004; 39 (10): 1460–1466.

    Article  Google Scholar 

  20. Hope WW, Mickiene D, Petraitis V, Petraitiene R, Kelaher AM, Hughes JE et al. The pharmacokinetics and pharmacodynamics of micafungin in experimental hematogenous Candida meningoencephalitis: implications for echinocandin therapy in neonates. J Infect Dis 2008; 197 (1): 163–171.

    Article  CAS  Google Scholar 

  21. Smith PB, Garges HP, Cotton CM, Walsh TJ, Clark RH, Benjamin Jr DK . Meningitis in preterm neonates: importance of cerebrospinal fluid parameters. Am J Perinatol 2008; 25 (7): 421–426.

    Article  Google Scholar 

  22. Greenberg RG, Smith PB, Cotten CM, Moody MA, Clark RH, Benjamin Jr DK . Traumatic lumbar punctures in neonates: test performance of the cerebrospinal fluid white blood cell count. Pediatr Infect Dis J 2008; 27 (12): 1047–1051.

    Article  Google Scholar 

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Acknowledgements

Dr Benjamin received support from NIH 1R01HD057956-02, 1R01FD003519-01, 1U10-HD45962-06, 1K24HD058735-01, and Government Contract HHSN267200700051C. Dr Smith received support from NICHD 1K23HD060040-01; Dr Greenberg received support from the NIH TL1 RR 024126.

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Authors and Affiliations

  1. Department of Pediatrics, Duke University, Durham, NC, USA

    R G Greenberg, D K Benjamin Jr, M Cohen-Wolkowiez, C M Cotten & P B Smith

  2. Duke Clinical Research Institute, Durham, NC, USA

    D K Benjamin Jr, M Cohen-Wolkowiez & P B Smith

  3. Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, USA

    R H Clark

  4. Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    M Laughon

Authors
  1. R G Greenberg
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  2. D K Benjamin Jr
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  3. M Cohen-Wolkowiez
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  4. R H Clark
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  5. C M Cotten
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  6. M Laughon
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  7. P B Smith
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Correspondence to P B Smith.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Greenberg, R., Benjamin, D., Cohen-Wolkowiez, M. et al. Repeat lumbar punctures in infants with meningitis in the neonatal intensive care unit. J Perinatol 31, 425–429 (2011). https://doi.org/10.1038/jp.2010.142

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  • DOI: https://doi.org/10.1038/jp.2010.142

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