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Characteristics of cerebrospinal fluid in term and preterm neonates without bacterial meningitis

Characteristics of cerebrospinal fluid in term and preterm neonates without bacterial meningitis
Age Mean WBC/mm3
(range or 95th percentile)
ANC/mm3 or percent PMNs
(range)
Mean protein (mg/dL)
(range or ±SD)
Mean glucose (mg/dL)
(range or ±SD)
Term neonates evaluated in the nursery setting
0 to 24 hours
(n = 135)*[1]
5 (0 to 90) 3/mm3 (0 to 70) 63 (32 to 240) 51 (32 to 78)
0 to 10 days
(n = 87)¶[2]
8.2 (0 to 32) 61.3% 90 (20 to 170) 52 (34 to 119)
Term neonates evaluated in the emergency department settingΔ
0 to 28 days
(n = 3467)[3]
5.5 (95th percentile 16) 2% (IQR 0 to 5) 69.9 (±25.7) 45.7 (±8.0)
Preterm very low birth weight (<1500 g) neonates

0 to 7 days

(n = 88)[4]
 7 (0 to 30) NR   144 (51 to 270)  50.4 (11 to 138)
0 to 28 days
(n = 45)[5]
5 (0 to 44) 8% (0 to 66) 148 (54 to 370) 67 (33 to 217)
WBC: white blood cell count; ANC: absolute neutrophil count; PMNs: polymorphonuclear leukocytes; SD: standard deviation; IQR: interquartile range; NR: not reported; CSF: cerebrospinal fluid.
* CSF obtained from term neonates without any obvious pathology.
¶ CSF obtained from hospitalized neonates at high risk for infection (eg, unexplained jaundice, prolonged rupture of membranes, maternal fever, etc); infection excluded by sterile cultures (CSF, blood, urine) and lack of clinical evidence of bacterial or viral infection.
Δ CSF obtained in the emergency department during evaluation for possible infection; infection was excluded by sterile cultures (CSF, blood, and urine). Infants with positive polymerase chain reaction for enterovirus were also excluded; however, not all infants underwent enteroviral testing. CSF parameters were similar in infants who tested negative for enterovirus and those who were not tested.
References:
  1. Naidoo BT. The cerebrospinal fluid in the healthy newborn infant. S Afr Med J 1968; 42:933.
  2. Sarff LD, Lynn H, Platt MD, et al. Cerebrospinal fluid evaluation in neonates: Comparison of high risk infants with and without meningitis. J Pediatr 1976; 88:473.
  3. Thomson J, Sucharew H, Cruz AT, et al. Cerebrospinal Fluid Reference Values for Young Infants Undergoing Lumbar Puncture. Pediatrics 2018; 141:e20173405.
  4. Mhanna MJ, Alesseh H, Gori A, Aziz HF. Cerebrospinal fluid values in very low birth weight infants with suspected sepsis at different ages. Pediatr Crit Care Med 2008; 9:294.
  5. Rodriguez AF, Kaplan SL, Mason EO. Cerebrospinal fluid values in the very low birth weight infant. J Pediatr 1990; 116:971.
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