JAMA Validation Finds Simple Tests Can Spare Many Febrile Newborns From Spinal Taps

Overview

• The study analyzed 2,531 infants 28 days and younger across multiple international cohorts and was led by Montreal Children's Hospital and Children's National Hospital.
• The updated PECARN rule deems an infant low risk with a negative urinalysis, serum procalcitonin at or below 0.5 ng/mL, and an absolute neutrophil count at or below 4,000 per mm³.
• Diagnostic performance showed 94.8% sensitivity and a 99.6% negative predictive value for invasive bacterial infections in the combined cohorts.
• No cases of bacterial meningitis were missed among infants classified as low risk, according to the JAMA report.
• The rule relies only on routine blood and urine tests and could reduce lumbar punctures and empiric intravenous antibiotics for select infants, with adoption dependent on guidelines, lab access to procalcitonin, and clinician judgment.