A Study on the Utility of Lumbar Puncture as a Diagnostic Marker for Meningitis in Neonatal Sepsis

primary outcome was to study the utility of LP in sepsis, and the secondary outcome was to study the clinical characteristics of the neonates with sepsis. MethodsThis is a retrospective comparative study conducted at two tertiary neonatal intensive care units (NICU) in India during the period from January 2017 to January 2020.The Institutional Ethics Committee approved the study, and a waiver of written informed consent was obtained.Neonates with CRP-positive sepsis (10 mg/L) admitted to the NICU were included.Those with suspected sepsis but IntroductIonNeonatal sepsis can be either proven sepsis or suspected sepsis.Clinically, it is a challenge to distinguish sepsis from sepsis with meningitis in neonates.Sepsis and meningitis have nonspecific clinical features, and meningitis may present without specific symptoms along with sepsis.The incidence of meningitis in neonatal sepsis has varied from 0.3 to 3% in various studies and is 0.5% according to the Indian National Neonatal Database report for the year 2000. 1 Studies from the United Kingdom (UK) and India reported an incidence of meningitis associated with lateonset sepsis (LOS) to be 3-30%. 2The need for lumbar puncture (LP) in neonates with suspected sepsis is justified, considering the morbidity and mortality associated with a missed or delayed diagnosis of meningitis.Early recognition of infants at risk for poor prognosis would be helpful in prompt management.On the other hand, the drawbacks of performing a LP in neonates must be considered.Lumbar puncture is an invasive procedure that carries risks of its own. 3,4Therefore, it is challenging to decide which neonate, as part of the septic workup, needs one.National Institute for Health and Care Excellence (NICE) CG149 recommendations suggest considering LP to evaluate for meningitis in early-onset sepsis (EOS) in neonates with C-reactive protein (CRP) level >10 mg/L, but the evidence for this is poorly defined. 5We conducted this study to compare practices of two units regarding the use of LP, as there are no clear guidelines stating the need for LP as part of the workup of neonatal sepsis and to propose a possible best practice.The