Should We Perform Lumbar Punctures on the First Day of Life?

In Reply .—In our series of 26 neonates with bacterial meningitis, four (15%) had onset of meningitis on day 1 of life. Two of these patients had negative blood cultures: one had group B streptococcus and died, while the other with Escherichia coli survived. The remaining two neonates with onset of meningitis on the first day of life had blood and spinal fluid cultures positive for group B streptococcus and both survived. Nine (56%) of 16 neonates with onset of meningitis at age younger than 8 days had negative blood cultures (Table). Our findings are similar to those of Shattuck and Chonmaitree and lend support to their recommendation that diagnostic lumbar puncture remain part of the routine assessment of the neonate with suspected sepsis.