Table 1 Studies evaluating the role of lumbar puncture to investigate early neonatal sepsis.

Citation	Study group	Study type	Outcome	Key results	Comments
Visser et al2	Newborn with suspected sepsis evaluated within 72 h of life. Total n = 323	Retrospective case notes review, level 2b	Incidence of meningitis	Total no of meningitis = 6, with the incidence of meningitis being 18/1000	Uncontrolled cohort. Indications of sepsis evaluation are not well described. No mentionwhether all suspected newborns were screened
Eldadah et al3	All infants admitted with RDS were evaluated for sepsis with LP within 24 h of life. n = 203	Prospective study, level 1b	No of cases with meningitis	No cases of meningitis were found. BC was positive in 17 infants	Study does not indicate any long‐term follow‐up, so no knowledge about missed cases of meningitis. Only included babies with RDS
Hendricks‐Munoz and Shapiro4	Newborns <34 weeks admitted with suspected sepsis or those with risk factors for sepsis was evaluated within 6 h. LP was carried out only in BC positive cases. Total no was 1390, of which 32 were BC positive; 15 of them died before CSF evaluation; 12 of these 15 patients had LP after death and 16 of the remaining 17 cases were evaluated with ante‐mortem LP	Retrospective case notes review, level 2b	No of cases of meningitis, number of missed/partially treated cases of meningitis	No cases of meningitis were found. No missed or partially treated cases were detected	Uncontrolled cohort. Small study but only looking at BC positive cases. Babies were treated with antibiotic before CSF was obtained, so the early meningeal seeding could be missed. No mention about the timing of follow‐up to detect missed cases
Weiss et al5	All infants admitted with respiratory distress on the first day of life had undergone LP as a part of sepsis screen. n = 1495	Retrospective case notes analysis, level 2b	Frequency of meningitis. Degree of association between meningitis and sepsis	4 cases of meningitis were detected with an incidence of 2.7/1000. BC were positive in 3 of these cases	Study included only babies admitted with respiratory distress on day 1 of life
Ajayi and Mokulu6	Phase 1: Newborns with suspected sepsis and those with risk factors for sepsis were evaluated within 72 h of age with lumbar puncture. n = 263. Phase 2: Newborns within 72 h of life with signs of severe sepsis only were evaluated with lumbar puncture. n = 50	Retrospective case notes review level 2b	No of LP done. No of cases of meningitis and no of missed or partially treated cases	3 times fewer LP carried out in phase 2 than in phase 1. No cases of meningitis detected in both phases (95% CI 0 to 1.1). No missed or partially treated cases of meningitis found	Uncontrolled cohort. No mention about timing of follow‐up to detect partially treated or missed cases. Estimated maximum risk was considered to avoid the fallacy inherent to zero numerators and the attendant complacency

BC, blood culture; CSF, cerebrospinal fluid; LP, lumbar puncture; RDS, respiratory distress syndrome.