#438 - 🔵 [PAS 2026] - Do Febrile Infants in Their First Month of Life Still Need a Lumbar Puncture?

Send us Fan MailDr. Nathan Kupperman and Dr. Brett Bernstein, lead investigators on a landmark international pooled analysis published in JAMA, present the most comprehensive evidence to date on whether a lumbar puncture can be safely avoided in febrile infants under one month of age. Using a simple three-criteria rule — negative urinalysis, procalcitonin of 0.5 or below, and absolute neutrophil count of 4,000 or below — across more than 2,500 prospectively collected cases from multiple international cohorts, the rule did not miss a single case of bacterial meningitis. They explain what this means for shared decision-making with families, why the number needed to perform a lumbar puncture to identify one case of bacterial meningitis is now vanishingly close to infinity for low-risk infants, and why implementing this approach requires a multidisciplinary coalition across emergency medicine, infectious disease, and inpatient teams before any individual physician changes their practice.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: [email protected]. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!