Evaluation of febrile infants under 3 months of age : Is routine lumbar puncture warranted ?
Fever may be the sole clinically evident presentation of serious bacterial infection (SBI) in a very young infant, and therefore lumbar puncture is still widely regarded as a mandatory procedure in the sepsis workup of febrile infants under 2 months of age.
In this retrospective study, we evaluated the frequency and the diagnostic value of cerebrospinal fluid examination in 492 infants aged less than 3 months who were hospitalized because of fever during 1988-1994.
The patients were categorized as being at « high risk » or « low risk » for SBI according to current clinical and laboratory criteria.
Among the 492 infants, 196 (40%) were identified as « high-risk » for SBI, and 296 (60%) were at low risk.
Among the overall series of infants, 60 babies (12%) were subsequently proven with bacterial infection.
Among the 196 « high-risk » babies, 26% had bacterial infection, compared to only 3% of the 296 infants at low risk (p<0.0001), denoting a sensitivity of 85% and a specificity of 65% of the clinical classification criteria.
Lumbar puncture was done to 186 (46%) infants upon hospital admission ; 176 punctures yielded satisfactory samples of cerebrospinal fluid (CSF).
Sixteen (3%) patients had abnormal CSF findings :
2 of them had positive bacterial cultures and 14 were compatible with aseptic meningitis.
The 2 patients with purulent meningitis were clinically very ill and were immediately recognized as deserving a lumbar puncture. (...)
Mots-clés Pascal : Fièvre, Epidémiologie, Nouveau né, Homme, Etiologie, Diagnostic, Evaluation, Ponction aspiration, Lombaire, Israël, Asie, Infection
Mots-clés Pascal anglais : Fever, Epidemiology, Newborn, Human, Etiology, Diagnosis, Evaluation, Aspiration punction, Lumbar, Israel, Asia, Infection
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0398239
Code Inist : 002B05A01. Création : 12/09/1997.