{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T12:24:51Z","timestamp":1794313491546,"version":"4.9.0"},"reference-count":29,"publisher":"American Academy of Pediatrics (AAP)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVES<\/jats:title>\n                  <jats:p>Lumbar punctures (LPs) are a common part of infant sepsis evaluations. Failures are estimated at 12% to 40%. Given limited literature on this topic, we describe characteristics, management, and outcomes for infants undergoing sepsis workup with successful vs unsuccessful initial LPs, including those who underwent repeat LP attempt.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We conducted a retrospective cross-sectional study of infants aged 0 to 60\u00a0days with LP performed during sepsis evaluation. Infants admitted to intensive care units, transferred from another hospital\u2019s inpatient unit, or with medical complexity were excluded. Descriptive statistics and logistic regression were performed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Of 468 infants, 386 had a successful initial LP (82%). Length of stay (LOS) was longer in infants with an unsuccessful initial LP (P\u2009=\u20090.02). Demographics, length of antibiotics, and readmission rate did not differ between groups. Infants with successful initial LPs were less likely to have viral testing (P\u2009=\u20090.019) and had shorter acyclovir courses (P\u2009=\u20090.026). Only 43% of infants with an unsuccessful initial LP underwent repeat LP attempt. Increased inflammatory markers were associated with repeat LP attempt.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Infants with unsuccessful initial LPs had increased LOS and resource use. Elevated inflammatory markers were associated with repeat LP attempt, and infants with repeat LPs had higher medical utilization. Prospective or multicenter studies are needed to further investigate outcomes and decision-making for infants with unsuccessful LPs and inform guidelines regarding repeat LPs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/hpeds.2024-008289","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:02:12Z","timestamp":1754524932000},"page":"758-768","source":"Crossref","is-referenced-by-count":2,"title":["What Happens When We Miss? Effect of Initial Lumbar Puncture Success on Infant Sepsis Evaluation"],"prefix":"10.1542","volume":"15","author":[{"given":"Amanda","family":"Dube","sequence":"first","affiliation":[{"name":"1Division of Pediatric Hospital Medicine, Rady Children\u2019s Hospital, San Diego, California"},{"name":"2Department of Pediatrics, University of California San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manaswitha","family":"Khare","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Hospital Medicine, Rady Children\u2019s Hospital, San Diego, California"},{"name":"2Department of Pediatrics, University of California San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Levy","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Hospital Medicine, Rady Children\u2019s Hospital, San Diego, California"},{"name":"2Department of Pediatrics, University of California San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Edmunds","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Hospital Medicine, Rady Children\u2019s Hospital, San Diego, California"},{"name":"2Department of Pediatrics, University of California San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aarti","family":"Patel","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Hospital Medicine, Rady Children\u2019s Hospital, San Diego, California"},{"name":"2Department of Pediatrics, University of California San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Begem","family":"Lee","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Hospital Medicine, Rady Children\u2019s Hospital, San Diego, California"},{"name":"2Department of Pediatrics, University of California San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiranun","family":"Rungvivatjarus","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Hospital Medicine, Rady Children\u2019s Hospital, San Diego, California"},{"name":"2Department of Pediatrics, University of California San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Mannino Avila","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Hospital Medicine, Rady Children\u2019s Hospital, San Diego, California"},{"name":"2Department of Pediatrics, University of California San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"issue":"2","key":"2025083119590020600_r1","doi-asserted-by":"crossref","first-page":"e2021052228","DOI":"10.1542\/peds.2021-052228","article-title":"Evaluation and management of well-appearing febrile infants 8 to 60\u00a0days old","volume":"148","author":"Pantell","year":"2021","journal-title":"Pediatrics."},{"issue":"7","key":"2025083119590020600_r2","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1177\/000992289303200703","article-title":"Efficacy of a protocol to distinguish risk of serious bacterial infection in the outpatient evaluation of febrile young infants","volume":"32","author":"Bonadio","year":"1993","journal-title":"Clin Pediatr (Phila)."},{"issue":"20","key":"2025083119590020600_r3","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1056\/NEJM199311113292001","article-title":"Outpatient management without antibiotics of fever in selected infants","volume":"329","author":"Baker","year":"1993","journal-title":"N Engl J Med."},{"issue":"1","key":"2025083119590020600_r4","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S0022-3476(05)80591-8","article-title":"Outpatient treatment of febrile infants 28 to 89\u00a0days of age with intramuscular administration of ceftriaxone","volume":"120","author":"Baskin","year":"1992","journal-title":"J Pediatr."},{"issue":"2","key":"2025083119590020600_r5","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1177\/000992280003900202","article-title":"Applying outpatient protocols in febrile infants 1\u201328\u00a0days of age: can the threshold be lowered","volume":"39","author":"Kadish","year":"2000","journal-title":"Clin Pediatr (Phila)."},{"issue":"4","key":"2025083119590020600_r6","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1542\/peds.108.4.866","article-title":"Enhanced urinalysis improves identification of febrile infants ages 60\u00a0days and younger at low risk for serious bacterial illness","volume":"108","author":"Herr","year":"2001","journal-title":"Pediatrics."},{"issue":"suppl 1","key":"2025083119590020600_r7","first-page":"A73","article-title":"658 Trends and techniques in infant lumbar puncture \u2013 towards a more standardised approach to maximise procedure success","volume":"106","author":"Cave","year":"2021","journal-title":"Arch Dis Child."},{"issue":"5","key":"2025083119590020600_r8","doi-asserted-by":"crossref","first-page":"e1237","DOI":"10.1542\/peds.2014-1911","article-title":"Impact of just-in-time and just-in-place simulation on intern success with infant lumbar puncture","volume":"135","author":"Kessler","year":"2015","journal-title":"Pediatrics."},{"issue":"2","key":"2025083119590020600_r9","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/acem.12582","article-title":"The effect of traumatic lumbar puncture on hospitalization rate for febrile infants 28 to 60\u00a0days of age","volume":"22","author":"Pingree","year":"2015","journal-title":"Acad Emerg Med."},{"issue":"33","key":"2025083119590020600_r10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/THJY0671","article-title":"Techniques to increase lumbar puncture success in newborn babies: the NeoCLEAR RCT","volume":"27","author":"Roehr","year":"2023","journal-title":"Health Technol Assess."},{"issue":"10","key":"2025083119590020600_r11","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1542\/hpeds.2014-0175","article-title":"Management of hospitalized febrile neonates without CSF analysis: a study of US pediatric hospitals","volume":"5","author":"Bhansali","year":"2015","journal-title":"Hosp Pediatr."},{"issue":"2","key":"2025083119590020600_r12","doi-asserted-by":"crossref","first-page":"e2024068028","DOI":"10.1542\/peds.2024-068028","article-title":"Resource utilization and cost in management of febrile infants after the 2021 clinical guideline","volume":"155","author":"Dingle","year":"2025","journal-title":"Pediatrics."},{"key":"2025083119590020600_r13","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.jpeds.2020.10.034","article-title":"Declines in the number of lumbar punctures performed at United States children\u2019s hospitals, 2009\u20132019","volume":"231","author":"Geanacopoulos","year":"2021","journal-title":"J Pediatr."},{"issue":"11","key":"2025083119590020600_r14","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1542\/hpeds.2021-006433","article-title":"Impact of CSF meningitis and encephalitis panel on resource use for febrile well-appearing infants","volume":"12","author":"DesPain","year":"2022","journal-title":"Hosp Pediatr."},{"issue":"3","key":"2025083119590020600_r15","doi-asserted-by":"crossref","first-page":"e20182201","DOI":"10.1542\/peds.2018-2201","article-title":"Reducing Variability in the Infant Sepsis Evaluation (REVISE): a national quality initiative","volume":"144","author":"Biondi","year":"2019","journal-title":"Pediatrics."},{"issue":"2","key":"2025083119590020600_r16","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform."},{"key":"2025083119590020600_r17","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform."},{"issue":"6","key":"2025083119590020600_r18","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/j.annemergmed.2006.10.018","article-title":"Risk factors for traumatic or unsuccessful lumbar punctures in children","volume":"49","author":"Nigrovic","year":"2007","journal-title":"Ann Emerg Med."},{"issue":"4","key":"2025083119590020600_r19","doi-asserted-by":"crossref","first-page":"e2024066420","DOI":"10.1542\/peds.2024-066420","article-title":"Parental preferences and shared decision-making for the management of febrile young infants","volume":"154","author":"Sylvestre","year":"2024","journal-title":"Pediatrics."},{"issue":"12","key":"2025083119590020600_r20","doi-asserted-by":"crossref","first-page":"e1213","DOI":"10.1097\/PEC.0000000000001977","article-title":"Parents\u2019 perspectives on communication and shared decision making for febrile infants \u226460\u00a0days old","volume":"37","author":"Aronson","year":"2021","journal-title":"Pediatr Emerg Care."},{"issue":"6","key":"2025083119590020600_r21","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1097\/PEC.0000000000002884","article-title":"The success of resident-associated lumbar punctures at a large, single-center children\u2019s hospital","volume":"39","author":"Rudloff","year":"2023","journal-title":"Pediatr Emerg Care."},{"issue":"5","key":"2025083119590020600_r22","doi-asserted-by":"crossref","first-page":"e2313354","DOI":"10.1001\/jamanetworkopen.2023.13354","article-title":"Prevalence of urinary tract infection, bacteremia, and meningitis among febrile infants aged 8 to 60\u00a0days with SARS-CoV-2","volume":"6","author":"Aronson","year":"2023","journal-title":"JAMA Netw Open."},{"issue":"2","key":"2025083119590020600_r23","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1542\/peds.112.2.282","article-title":"Prevalence of serious bacterial infections in febrile infants with respiratory syncytial virus infection","volume":"112","author":"Titus","year":"2003","journal-title":"Pediatrics."},{"key":"2025083119590020600_r24","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.ajem.2021.09.069","article-title":"Frequency of serious bacterial infections in young infants with and without viral respiratory infections","volume":"50","author":"Greenfield","year":"2021","journal-title":"Am J Emerg Med."},{"issue":"2","key":"2025083119590020600_r25","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/S2352-4642(22)00343-1","article-title":"Assessment of infant position and timing of stylet removal to improve lumbar puncture success in neonates (NeoCLEAR): an open-label, 2\u2009\u00d7\u20092 factorial, randomised, controlled trial","volume":"7","author":"Marshall","year":"2023","journal-title":"Lancet Child Adolesc Health."},{"issue":"3","key":"2025083119590020600_r26","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1542\/peds.2005-0519","article-title":"Local anesthetic and stylet styles: factors associated with resident lumbar puncture success","volume":"117","author":"Baxter","year":"2006","journal-title":"Pediatrics."},{"issue":"3","key":"2025083119590020600_r27","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1542\/hpeds.2022-006799","article-title":"Equity in receipt of a lumbar puncture for febrile infants at an academic center","volume":"13","author":"Taft","year":"2023","journal-title":"Hosp Pediatr."},{"key":"2025083119590020600_r28","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.jpeds.2018.04.033","article-title":"Epidemiology and etiology of invasive bacterial infection in infants \u226460\u00a0days old treated in emergency departments","volume":"200","author":"Woll","year":"2018","journal-title":"J Pediatr."},{"issue":"12","key":"2025083119590020600_r29","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1542\/hpeds.2020-000638","article-title":"Febrile infants \u226460\u00a0days old with positive urinalysis results and invasive bacterial infections","volume":"10","author":"Yankova","year":"2020","journal-title":"Hosp Pediatr."}],"container-title":["Hospital Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/15\/9\/758\/1840916\/hosppeds.2024008289.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/15\/9\/758\/1840916\/hosppeds.2024008289.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T23:59:13Z","timestamp":1756684753000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article\/15\/9\/758\/203071\/What-Happens-When-We-Miss-Effect-of-Initial-Lumbar"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":29,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,8,7]]},"published-print":{"date-parts":[[2025,9,1]]}},"URL":"https:\/\/doi.org\/10.1542\/hpeds.2024-008289","relation":{},"ISSN":["2154-1663","2154-1671"],"issn-type":[{"value":"2154-1663","type":"print"},{"value":"2154-1671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,7]]}}}