Indications of Lumbar Puncture in Children, and their Outcome at 2 Hospitals Under Barking Havering and Redbridge Nhs Trust

Abstract

Objectives To describe the indication of performing lumbar punctures in children and their outcome. To determine the limitations of the outcome assessment to improve our practice. Methods The study was over a period of 14 months from January 22 to March 23. Children with age ranging from Day 1 to 16th birthday admitted in the paediatric ward were included. Data was obtained from the pathology laboratory for analysis during that period. Results Hundred and thirty-nine children's data were enrolled. Among them,42 (30.21%) were neonates, 49 (35.25%) were children between 1month to 3months old and the rest were more than 3months old. Most common symptoms were fever (49%), reduced feeding (18%), seizures (9%) and irritability (9%). Clinically unwell children were 29 (20.86%) and 44 (31.65%) had normal examination. Remaining had seizures (7.19%), fever (4.32%) and nasal congestion (5.04%). Lumbar punctures were performed for suspected sepsis in 93 cases (67%), suspected encephalitis in 13 (9%) and suspected meningitis in 10 (7%) of the cases. Nine children had lumbar puncture after discussion with tertiary hospital. Among 139 children, 106 (76.2%) were started on parenteral antibiotics and 17 (12.2%) children had antibiotics before the lumbar puncture procedure. Ceftriaxone was the most used antibiotic (30.21%) followed by cefotaxime with amoxicillin (16.5%) Blood and CSF cultures were positive in children with white cell count between 5 to 15 and more than 15. CSF culture was positive in 5.03% and blood culture was positive in 8.76% of the children. Three children with C-reactive protein >100 had positive blood culture results and one had positive CSF culture. CSF results containing neutrophil had 3 positive blood cultures and 6 positive CSF cultures. CSF protein was high in 26.6% children and 13.6% had low CSF glucose. Most common diagnosis was suspected sepsis (25.8%), viral illness (9.3%),seizures (7.19%) and UTI (5.7%). Twelve children required transfer to tertiary hospital for further evaluation and 2 had Psychiatry illness Conclusion Suspected sepsis was the most common indication for lumbar puncture and the final diagnosis. Among 139 lumbar punctures, only 12 had positive blood cultures and 7 had positive CSF culture. History, background, examination, timing and total duration of antibiotics, simultaneous recording of blood glucose and CSF glucose levels during Lumbar Puncture and follow up plan should be documented clearly.