Management of Young Infants with Incomplete Evaluation for Meningitis

Evaluation of neonates and young infants with fever is a common problem in pediatrics. Lumbar puncture is frequently indicated, but results are often difficult to interpret due to dry tap, blood contamination, and/or antibiotic pretreatment. Pediatric infectious diseases clinicians are often called upon to determine the risk of meningitis requiring definitive treatment in the absence of optimal data. Pediatric clinicians can use clinical data, such as age, physical exam, and lab values to estimate the pre-test probability of meningitis and may be able to use ancillary testing, such as imaging and molecular microbiology, to refine the estimate. The goal of this review is to provide an evidence-based approach to this common scenario.