Resumen

DIAZ ALVAREZ, Manuel; VIEL REVOLTA, Yamilka; ARANGO ARIAS, María Isabel  y  CLAVER ISAS, Daniel. The febrile newborn infant with signs of focalization and with failed lumbar puncture in the initial evaluation. Rev Cubana Pediatr [online]. 2008, vol.80, n.1. ISSN 0034-7531.

INTRODUCTION. The lumbar puncture is indicated in the initial evaluation of the febrile newborn without signs of focalization. However, it may fail and create uncertainty in the management of the antibiotic treatment. The objective of this paper was to verify the treatment and evolution of the febrile newborn infants without signs of focalization, when the lumbar puncture failed in the initial evaluation. METHODS. 150 febrile newborn infants without signs of focalization and with failed lumbar puncture in the initial evaluation that were admitted in the neonatology service of our hospital between 1992 and 2000 were studied. All the patients were classified according to the criterion of low risk of severe bacterial infection. The use of antibiotic treatment was subjected to the consideration of the physician that made the initial evaluation. The index and rate of failed lumbar puncture were calculated and the relation between the indication of the antibiotic treatment at the beginning and the classification of severe bacterial infection risk was measured. The evolution of the patients was checked. RESULTS. 150 of the 1174 lumbar punctures failed (8.5 %) for an index of 9.2. The newborn infants considered as high risk received antibiotic treatment more frequently (23.3 %) compared with those classified as low risk, who were predominantly treated without antibiotics (36.0 %) (p = 0.03). 149 neonates were discharged alive (99.3 %), with or without use of antibiotics. However, there was a dead child classified as high risk for severe bacterial infection that received antibiotic treatment from the beginning. CONCLUSIONS. The lumbar puncture may fail on evaluating the febrile newborn infants without signs of focalization. The indication of antimicrobial treatment in these patients was significantly connected with the classification of risk for severe bacterial infection, and the management of the antibiotic treatment before a failed lumbar puncture did not determine an adverse evolution.

Palabras clave : Newborn infant; lumbar puncture; fever; antibiotic treatment.

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