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Open Access Research article

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

Stephen W Patrick123*, Robert E Schumacher13 and Matthew M Davis12456

Author Affiliations

1 Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan, 48109, USA

2 Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan Health System, Ann Arbor, Michigan, 48109, USA

3 Division of Neonatal-Perinatal Medicine, University of Michigan Health System, Ann Arbor, Michigan, 48109, USA

4 Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan, 48109, USA

5 Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan, 48109, USA

6 6312 Medical Science Building 1 1150 W. Medical Center Drive SPC 5604, Ann Arbor, Michigan, 48109-5604, USA

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BMC Pediatrics 2012, 12:134  doi:10.1186/1471-2431-12-134

Published: 28 August 2012

Abstract

Background

Whether lumbar punctures (LPs) should be performed routinely for term newborns suspected of having early onset neonatal sepsis (EONS) is subject to debate. It is unclear whether variations in performance of LPs for EONS may be associated with patient, hospital, insurance or regional factors. Our objective was to identify characteristics associated with the practice of performing LPs for suspected EONS in a nationally representative sample.

Methods

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.

Results

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.

Conclusions

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.

Keywords:
Neonatal; Sepsis; Lumbar puncture; Variation; Early onset neonatal sepsis