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Is LP Needed for Febrile Infants 29-60 days with Abnormal UA?

October 14, 2022

Written by Clay Smith

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Febrile infants 29-60 days with a positive UA had no cases of bacterial meningitis. These patients do not need a lumbar puncture (LP).

Why does this matter?
If a febrile infant ≤60 days has a positive UA, does this put them at greater risk of bacteremia or bacterial meningitis? In other words, do we need to do a LP on these infants?

This reinforces my practice
This was a secondary analysis of prospectively collected data on 7,180 febrile, non-critically ill infants ≤60 days old. Of these, 1,090 (15.2%) had a positive UA, defined as any nitrite, leukocyte esterase, or >5 WBCs/hpf. In patients with a positive UA, bacteremia was more common: 5.8% vs 1.1%. So, do a blood culture for sure. The risk of bacterial meningitis was the same in infants ≤28 days with (1%) or without (1.3%) a positive UA; I do a LP on most infants ≤28 days regardless. Infants 29-60 days old with a positive UA had zero cases of bacterial meningitis (out of 697 patients, 0%); those with a negative UA had 9 cases of bacterial meningitis (out of 4,153, 0.2%). 148 infants ≤60 days with a positive UA had PECARN lab markers drawn and met low-risk lab criteria (ANC <4,000 and procalcitonin <0.5 ng/mL), and none had bacteremia or meningitis. This study boosts my confidence and reinforces my practice to avoid LP in 29-60 day old infants with a positive UA.

Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results. Pediatrics. 2022 Sep 13;e2021055633. doi: 10.1542/peds.2021-055633. Online ahead of print.

What are your thoughts?