Reducing Lumbar Punctures for Febrile Newborns

Published on in CHOP News

House iconKeep Kids out of the Hospital
4 arrows pointing to the center of a circle iconReduce Unnecessary Care

Why is this important?

Infants in the first two months of life have a higher risk of serious bacterial infection, including meningitis. Standard care includes evaluation of blood, urine and spinal fluid for infection followed by empiric treatment until cultures results are available. Review of recent evidence documented very low risk for meningitis in well-appearing infants in the second month of life who meet low-risk screening criteria after initial laboratory studies.

What we did

The Febrile Infant Clinical Pathway team reviewed existing evidence, and then reviewed the data from infants who were cared for here at Children's Hospital of Philadelphia (CHOP). The team documented the very low risk of meningitis in older infants that meet low risk criteria. They revised the existing clinical pathway, educated the team, and then implemented the change. The team continues to monitor the outcomes of all infants treated using this pathway. 


Percent of ED Febrile Infants 29-56 Days of Age Discharged Home without a Spinal Tap

Almost 100 percent of infants with fever who met low risk criteria were safely discharged home without having a spinal tap.

Graph: percent with no lumbar punctures

Updated May, 2020