Variation in lumbar punctures for early onset neonatal sepsis: a nationally representative serial cross-sectional analysis, 2003-2009

Utilizing data from the 2003, 2006 and 2009 Kids’ Inpatient Database (KID) compiled by the Agency for Healthcare Research and Quality, we examined the frequency and characteristics of term, normal-birth weight newborns receiving an LP for EONS. Survey-weighting was applied for national estimates and used in chi squared and multivariable regression analysis.In 2009, there were 13,694 discharges for term newborns that underwent LPs for apparent EONS. Newborns having LPs performed were more likely to be covered by Medicaid vs. private insurance (51.9 vs. 45.1 percent; p < 0.001), be born in urban vs. rural hospitals (94.8 vs. 87.3 percent; p < 0.001), teaching vs. non-teaching (60.8 vs. 43.1 percent; p < 0.001) and children’s hospitals vs. non-children’s (23.0 vs. 11.2 percent; p < 0.001). Lastly, newborns having LPs performed were disproportionately born in the Northeast census region (p = 0.03). In multi-year adjusted analysis, infants with Medicaid coverage, and those born in urban or teaching hospitals, consistently had higher odds of having an LP performed.We found pronounced variation in LPs performed for EONS, even when adjusting for clinical conditions that would prompt LPs. These findings indicate practice variations in newborn care that merit further examination and explanation.Lumbar punctures (LPs) are commonly performed on newborns suspected of having sepsis [1]. Over the last thirty years, numerous studies have evaluated the utility of LPs in identifying early onset neonatal sepsis (EONS). While several studies found that LPs were unnecessary among asymptomatic newborns suspected of having EONS for risk factors related to maternal reasons [2-4] or with respiratory signs [5,6], other analyses found that cases of meningitis were missed when an LP was not performed on this population [7,8].In 2002, the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) [9] released guidelines for the diagnostic approach of a newborn