Ajayi O A, Mokuolu O A
Department of Paediatrics/Child Health, University of Ilorin/University Teaching Hospital, Nigeria.
Trop Med Int Health. 1997 Mar;2(3):284-8. doi: 10.1046/j.1365-3156.1997.d01-270.x.
To determine whether lumbar puncture is necessary in the evaluation of neonates with risk for infection or suspected sepsis in the first 72 hours of life, we reviewed the laboratory and medical records of 506 infants who had lumbar punctures between January 1988 and December 1990. Neonates < 72 hours of age accounted for 52% of all lumbar punctures, but no case of meningitis. This led to a policy shift from routinely performing lumbar punctures to reserving them for infants with signs of severe sepsis (i.e. lethargy, hypothermia, hypotonia, poor perfusion or apnoea), specific neurological signs or clinical deterioration. This new policy was monitored prospectively from July 1991 to December 1993. Three times fewer procedures were performed in neonates < 72 hours, and there was no diagnosed or missed case of meningitis. Given that meningitis is rare within the first 72 hours of life and the yield of lumbar puncture virtually zero, we recommend that lumbar punctures be reserved for selected infants.
为确定在出生后72小时内对有感染风险或疑似败血症的新生儿进行评估时腰椎穿刺是否必要，我们回顾了1988年1月至1990年12月期间进行腰椎穿刺的506例婴儿的实验室检查和病历。72小时龄以下的新生儿占所有腰椎穿刺病例的52%，但无一例脑膜炎病例。这导致了一项政策转变，即从常规进行腰椎穿刺改为仅对有严重败血症体征（即嗜睡、体温过低、肌张力减退、灌注不良或呼吸暂停）、特定神经系统体征或临床病情恶化的婴儿进行腰椎穿刺。从1991年7月至1993年12月对这一新政策进行了前瞻性监测。72小时龄以下新生儿的腰椎穿刺操作次数减少了三分之二，且没有诊断出或漏诊的脑膜炎病例。鉴于脑膜炎在出生后72小时内很少见，且腰椎穿刺的阳性率几乎为零，我们建议仅对选定的婴儿进行腰椎穿刺。
