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LP for febrile 22-28 days?

(Click the link to comment and to vote – voting not working through email, sorry!)

Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

The new AAP Subcommittee on the Febrile Infant guidelines for managing febrile 8-60 day olds gives the option to perform an LP for febrile 22-28 day olds only if inflammatory markers, if obtained, are abnormal (Temp > 38.5, Procalcitonin > 0.5 ng/mL, CRP > 20 mg/dL, ANC > 4500-5200). This is an option even for the infant with a + UA. If an LP is not performed, they do recommend admission to the hospital and treatment with parenteral antibiotics. This is a change from prior practice, where concerns about masking meningitis obviated administration of parenteral antibiotics without performing the LP. What are your thoughts?

LP for 22-28 day olds?

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pemsou5_wp • August 13, 2021

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  1. Kelly August 30, 2021 - 11:47 am Reply

    Here is what the AAP Guidelines say: “In infants < 28 days of age, none of the 21 cases of bacterial meningitis in the PROS, PECARN, and step-by-step studies were missed (sensitivity 100%; CI, 84-100%). Using a bacterial meningitis prevalence in 22- to 28-day-old infants of… ~1 in 200 to 250 and the lower end of sensitivity CI (84%) suggests 1250 to 1560 interpretable CSF samples would be required to detect each additional case of bacterial meningitis (number needed to test = 1250-1560)."

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