NEW YORK (Reuters Health) – Lumbar puncture is not necessary in febrile infants with a bulging fontanelle, provided that they appear well and that laboratory and imaging studies yield no evidence of bacterial disease, according to a report in the Archives of Disease in Childhood for September.

Infants with fever and a bulging fontanelle usually have self-limited conditions. Despite a lack of clinical evidence, however, it remains common practice to perform a lumbar puncture in such infant to rule-out bacterial meningitis.

In the present study, Dr. Shira Shacham, from Assaf Harofeh Medical Center, Zerifin, Israel, and colleagues analyzed data from 153 infants with fever and bulging fontanelle who underwent lumbar puncture between 2000 and 2008.

The infants’ average age was 5.6 months. Forty-two (27.3%) were found to have cerebrospinal fluid pleocytosis, including one with bacterial meningitis (0.6%).

Other leading diagnoses included aseptic meningitis (26.7%), upper respiratory tract infection (18.3%), viral disease not otherwise specified (15.6%), roseola infantum (8.5%), and acute otitis media (6.5%).

Nearly 74% (113) of infants looked well clinically on admission and none of these ended had bacterial meningitis. Thirty-two of the babies who looked well on admission had aseptic meningitis, and 17 had other bacterial disease. All of the infants with bacterial disease had a laboratory or imaging study suggesting a bacterial cause.

“We cautiously suggest that in an infant who appears well and in whom there is no other indication for prompt antibiotic treatment, it is reasonable to observe the infant and withhold a lumbar puncture,” the authors conclude.

Reference:
Arch Dis Child 2009;94:690-692.