315 - Characteristics of infants undergoing sepsis evaluations after initially successful versus unsuccessful lumbar punctures

Poster Number: 315
Publication Number: 315.52

Background: Lumbar punctures (LPs) are commonly performed as part of sepsis evaluations for febrile infants. Failures are estimated at 12-40%. There is no current literature on outcomes or management for infants in whom an initial LP was unsuccessful.

Objective: Describe characteristics and outcomes of infants in whom the initial LP was successful (defined as obtaining sufficient cerebrospinal fluid (CSF) for minimum necessary testing) and infants in whom the initial LP was unsuccessful.

Design/Methods: This single-center retrospective chart review study at a tertiary care freestanding children’s hospital from 1/1/2019 – 12/31/2022 included patients 0-60 days old who had an LP performed as part of a sepsis evaluation. We excluded patients admitted or transferred to an intensive care unit within 24 hours of admission, patients with medical complexity, those transferred from another hospital’s inpatient unit, or patients on whom an LP was obtained for a reason other than sepsis evaluation. Both data pull and manual chart review were conducted. Statistical analysis was performed using R version 4.2.3.

Results: Of the 468 patients included, 82% of patients had a successful first LP (n = 386). Of the patients with an initially unsuccessful LP (n = 82), 44% had at least one repeat LP (n = 36). Success rate for first repeat LP was 66% (24/36). Length of stay (LOS) was longer in patients with an initially unsuccessful LP (p = 0.02). Demographics, number of intravenous antibiotic hours, and readmission rate did not differ between patients with an initially successful versus initially unsuccessful LP (Tables 1 and 2). Elevated CRP was associated with higher likelihood of repeat LP, when controlling for age, ANC, and viral testing. For patients on whom repeat LP was not attempted, well appearance, reassuring labs, and high suspicion for viral illness were the most commonly documented reasons (Table 3). Of patients with an initially unsuccessful LP (n = 54), 66% never had CSF obtained. Of these, none were diagnosed with bacteremia or meningitis, and none had readmissions within 7 days.

Conclusion(s): In infants undergoing sepsis evaluation at our tertiary care children’s hospital over the past 4 years, 56% patients with initially unsuccessful LPs did not have a repeat LP attempted. Apart from a small increase in LOS, no significant differences in outcomes were observed between patients who had initially successful versus unsuccessful LP. Further studies are needed to continue to assess outcomes and decision-making for infants with unsuccessful LPs.