JAMA

Prediction tool may guide lumbar puncture decisions for infants

December 12, 2025

A pooled analysis of 4 prospective cohorts (N = 1,537) evaluated the updated PECARN prediction rule for febrile infants ≤28 days. Infants were classified as low risk if they had negative urinalysis, serum procalcitonin ≤0.5 ng/mL, and absolute neutrophil count ≤4,000/mm³. Among participants, 69 (4.5%) had invasive bacterial infections, including 11 (0.7%) with meningitis; 41% met low-risk criteria. The rule demonstrated high sensitivity (94.2%) and negative predictive value (99.4%) for bacteremia or meningitis, with no missed meningitis cases, though specificity was modest (41.6%). Findings suggest the rule may support shared decision-making on selective vs. routine lumbar puncture in well-appearing febrile neonates.

Clinical takeaway: The updated PECARN rule reliably identifies low-risk infants, potentially reducing unnecessary invasive testing.

Source:

Burstein B, et al. (2025, December 8). JAMA. Prediction of Bacteremia and Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. https://pubmed.ncbi.nlm.nih.gov/41359314/