title: To tap or not to tap: high likelihood of meningitis without sepsis among very low birth weight infants.
abstract: BACKGROUND
  Neonatal meningitis is associated with significant morbidity and mortality. We speculated that meningitis may be underdiagnosed among very low birth weight (VLBW) infants because of the failure to perform lumbar punctures (LPs) in infants with suspected sepsis.
  
  
  OBJECTIVE
  This study was undertaken to review the epidemiology of late-onset meningitis in VLBW (401-1500 g) infants and to evaluate the concordance of cerebrospinal fluid (CSF) and blood culture (BC) results.
  
  
  METHODS
  VLBW infants (excluding those with intraventricular shunts) born at centers of the National Institute of Child Health and Human Development Neonatal Research Network from September 1, 1998, through December 31, 2001, were studied. Late-onset meningitis was defined by culture-based criteria and classified as meningitis with or without associated sepsis. Unadjusted comparisons were made using chi2 tests and adjusted comparisons using regression models.
  
  
  RESULTS
  Of 9641 VLBW infants who survived >3 days, 2877 (30%) had > or = 1 LPs, and 6056 (63%) had > or = 1 BC performed after day 3. One hundred thirty-four infants had late-onset meningitis (1.4% of all patients; 5% of those with an LP). Pathogens associated with meningitis were similar to those associated with sepsis. One third (45 of 134) of the infants with meningitis had negative BCs. Lower gestational age and prior sepsis increased risk for meningitis. Compared with uninfected infants, those with meningitis had a longer time on mechanical ventilation (28 vs 18 days), had longer hospitalizations (91 vs 79 days), were more likely to have seizures (25% vs 2%), and were more likely to die (23% vs 2%).
  
  
  CONCLUSIONS
  Meningitis is a serious complication among VLBW infants, associated with increased severity of illness and risk of death. Of note, one third of the infants with meningitis had meningitis in the absence of sepsis. Because CSF cultures were performed only half as often as BCs, this discordance in blood and CSF culture results suggests that meningitis may be underdiagnosed among VLBW infants.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Nellie
authors.initials: N
authors.lastname: Hansen
authors.forename: Avroy A
authors.initials: AA
authors.lastname: Fanaroff
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ehrenkranz
authors.forename: James A
authors.initials: JA
authors.lastname: Lemons
authors.forename: Edward F
authors.initials: EF
authors.lastname: Donovan
authors.forename: Ann R
authors.initials: AR
authors.lastname: Stark
authors.forename: Jon E
authors.initials: JE
authors.lastname: Tyson
authors.forename: William
authors.initials: W
authors.lastname: Oh
authors.forename: Charles R
authors.initials: CR
authors.lastname: Bauer
authors.forename: Sheldon B
authors.initials: SB
authors.lastname: Korones
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: David K
authors.initials: DK
authors.lastname: Stevenson
authors.forename: Lu-Ann
authors.initials: LA
authors.lastname: Papile
authors.forename: W Kenneth
authors.initials: WK
authors.lastname: Poole
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008581:Meningitis / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000453:epidemiology*; D018805:Sepsis; D013129:Spinal Puncture