To Tap or Not to Tap: High Likelihood of Meningitis Without Sepsis among Very Low Birth Weight Infants

Barbara J. Stoll, Nellie Hansen, Avroy A. Fanaroff, Linda L. Wright, Waldemar A. Carlo, Richard A. Ehrenkranz, James A. Lemons, Edward F. Donovan, Ann R. Stark, Jon E. Tyson, William Oh, Charles R Bauer, Sheldon B. Korones, Seetha Shankaran, Abbot R. Laptook, David K. Stevenson, Lu Ann Papile, W. Kenneth Poole

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

Context. 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 χ2 tests and adjusted comparisons using regression models. Results. Of 9641 VLBW infants who survived >3 days, 2877 (30%) had ≥1 LPs, and 6056 (63%) had >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 under-diagnosed among VLBW infants.

Original languageEnglish
Pages (from-to)1181-1186
Number of pages6
JournalPediatrics
Volume113
Issue number5 I
DOIs
StatePublished - May 1 2004

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Very Low Birth Weight Infant
Meningitis
Sepsis
Spinal Puncture
Cerebrospinal Fluid
National Institute of Child Health and Human Development (U.S.)
Artificial Respiration
Gestational Age

Keywords

  • Lumbar puncture
  • Meningitis
  • Sepsis
  • Very low birth weight infants

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Stoll, B. J., Hansen, N., Fanaroff, A. A., Wright, L. L., Carlo, W. A., Ehrenkranz, R. A., ... Poole, W. K. (2004). To Tap or Not to Tap: High Likelihood of Meningitis Without Sepsis among Very Low Birth Weight Infants. Pediatrics, 113(5 I), 1181-1186. https://doi.org/10.1542/peds.113.5.1181

To Tap or Not to Tap : High Likelihood of Meningitis Without Sepsis among Very Low Birth Weight Infants. / Stoll, Barbara J.; Hansen, Nellie; Fanaroff, Avroy A.; Wright, Linda L.; Carlo, Waldemar A.; Ehrenkranz, Richard A.; Lemons, James A.; Donovan, Edward F.; Stark, Ann R.; Tyson, Jon E.; Oh, William; Bauer, Charles R; Korones, Sheldon B.; Shankaran, Seetha; Laptook, Abbot R.; Stevenson, David K.; Papile, Lu Ann; Poole, W. Kenneth.

In: Pediatrics, Vol. 113, No. 5 I, 01.05.2004, p. 1181-1186.

Research output: Contribution to journalArticle

Stoll, BJ, Hansen, N, Fanaroff, AA, Wright, LL, Carlo, WA, Ehrenkranz, RA, Lemons, JA, Donovan, EF, Stark, AR, Tyson, JE, Oh, W, Bauer, CR, Korones, SB, Shankaran, S, Laptook, AR, Stevenson, DK, Papile, LA & Poole, WK 2004, 'To Tap or Not to Tap: High Likelihood of Meningitis Without Sepsis among Very Low Birth Weight Infants', Pediatrics, vol. 113, no. 5 I, pp. 1181-1186. https://doi.org/10.1542/peds.113.5.1181
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA et al. To Tap or Not to Tap: High Likelihood of Meningitis Without Sepsis among Very Low Birth Weight Infants. Pediatrics. 2004 May 1;113(5 I):1181-1186. https://doi.org/10.1542/peds.113.5.1181
Stoll, Barbara J. ; Hansen, Nellie ; Fanaroff, Avroy A. ; Wright, Linda L. ; Carlo, Waldemar A. ; Ehrenkranz, Richard A. ; Lemons, James A. ; Donovan, Edward F. ; Stark, Ann R. ; Tyson, Jon E. ; Oh, William ; Bauer, Charles R ; Korones, Sheldon B. ; Shankaran, Seetha ; Laptook, Abbot R. ; Stevenson, David K. ; Papile, Lu Ann ; Poole, W. Kenneth. / To Tap or Not to Tap : High Likelihood of Meningitis Without Sepsis among Very Low Birth Weight Infants. In: Pediatrics. 2004 ; Vol. 113, No. 5 I. pp. 1181-1186.
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abstract = "Context. 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 χ2 tests and adjusted comparisons using regression models. Results. Of 9641 VLBW infants who survived >3 days, 2877 (30{\%}) had ≥1 LPs, and 6056 (63{\%}) had >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 under-diagnosed among VLBW infants.",
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T2 - High Likelihood of Meningitis Without Sepsis among Very Low Birth Weight Infants

AU - Stoll, Barbara J.

AU - Hansen, Nellie

AU - Fanaroff, Avroy A.

AU - Wright, Linda L.

AU - Carlo, Waldemar A.

AU - Ehrenkranz, Richard A.

AU - Lemons, James A.

AU - Donovan, Edward F.

AU - Stark, Ann R.

AU - Tyson, Jon E.

AU - Oh, William

AU - Bauer, Charles R

AU - Korones, Sheldon B.

AU - Shankaran, Seetha

AU - Laptook, Abbot R.

AU - Stevenson, David K.

AU - Papile, Lu Ann

AU - Poole, W. Kenneth

PY - 2004/5/1

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N2 - Context. 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 χ2 tests and adjusted comparisons using regression models. Results. Of 9641 VLBW infants who survived >3 days, 2877 (30%) had ≥1 LPs, and 6056 (63%) had >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 under-diagnosed among VLBW infants.

AB - Context. 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 χ2 tests and adjusted comparisons using regression models. Results. Of 9641 VLBW infants who survived >3 days, 2877 (30%) had ≥1 LPs, and 6056 (63%) had >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 under-diagnosed among VLBW infants.

KW - Lumbar puncture

KW - Meningitis

KW - Sepsis

KW - Very low birth weight infants

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