5927 The use of lumbar puncture for infants aged 28 days and under admitted with suspected sepsis to the General Paediatric ward

Objectives The NICE guideline for fever in under 5s¹ advises that all infants aged under 1 month old presenting with a fever should have a lumbar puncture as part of the septic screen. The aim of this audit was to identify the incidence of lumbar puncture in infants aged 28 days and under admitted to the General Paediatric ward with suspected sepsis. Secondary objectives were to identify reasoning for not performing a lumbar puncture, and time between admission and cerebrospinal fluid (CSF) samples reaching the laboratory. Methods Using local digital patient record software, all admissions aged 28 days and under to the General Paediatric ward between the 1st January and 31st December 2022 were identified. Using scanned medical notes and digital patient records, infants who received broad spectrum antibiotic treatment for suspected sepsis were selected. Digital pathology records were used to identify CSF samples received by the laboratory. Results There were 364 admissions of infants aged 28 days and under to the General Paediatric ward between 1st January and 31st December 2022. 72 of these infants were treated for suspected sepsis. 57% of those who presented with fever had CSF samples received in the laboratory. 79% of CSF samples reached the laboratory within 24 hours of admission time. Of those who did not have CSF samples sent to the laboratory, 35% had an alternative diagnosis made and 19% had a documented unsuccessful attempt at lumbar puncture. In 32% of cases there was no documentation of reasoning for not performing a lumbar puncture, and no documented unsuccessful attempts. Conclusion Incidence of lumbar puncture in infants aged 28 days and under presenting with fever can be improved. Time between admission and CSF samples reaching the laboratory can also be improved. Documentation of clinical decisions is essential so that the reasoning for not performing a lumbar puncture is clear. Reference Fever in under 5s: assessment and initial management, NICE guideline [NG143], 26 November 2021.