Kumar P, Sarkar S, Narang A
Department of Pediatrics, PGIMER, Chandigarh, India.
J Paediatr Child Health. 1995 Feb;31(1):8-10. doi: 10.1111/j.1440-1754.1995.tb02902.x.
To evaluate the utility of lumbar puncture done routinely as part of complete workup in neonatal sepsis.
Two hundred and nine consecutive lumbar punctures performed in 169 neonates were prospectively evaluated for the diagnosis of meningitis over a 6 month period in a tertiary care referral neonatal unit.
Among babies with 'suspected clinical sepsis', five (3.3%) were diagnosed to have meningitis. None of the clinically normal babies with high risk obstetric factors alone had meningitis. The lumbar puncture was traumatic in 22.9%, and in 26.3% the fluid obtained was inadequate for complete analysis. The results were inconclusive in 37% of the cases.
Based on this study, routine lumbar puncture may not be required in clinically normal newborns with adverse obstetric factors. In babies with clinical sepsis, though the yield is not very high; there are no reliable clinical or laboratory markers to predict which babies will have meningitis and hence these babies would warrant a lumbar puncture.
评估在新生儿败血症全面检查中常规进行腰椎穿刺的效用。
在一家三级医疗转诊新生儿病房，对169例新生儿连续进行的209次腰椎穿刺进行了为期6个月的前瞻性评估，以诊断脑膜炎。
在“疑似临床败血症”的婴儿中，有5例（3.3%）被诊断为患有脑膜炎。仅具有高危产科因素的临床正常婴儿均未患脑膜炎。腰椎穿刺有22.9%出现创伤，26.3%获取的脑脊液不足以进行全面分析。37%的病例结果无定论。
基于本研究，对于具有不良产科因素的临床正常新生儿，可能无需常规进行腰椎穿刺。对于临床败血症患儿，尽管检出率不高；但没有可靠的临床或实验室指标来预测哪些婴儿会患脑膜炎，因此这些婴儿需要进行腰椎穿刺。
