Age‐specific reference values for cerebrospinal fluid protein concentration in neonates and young infants

Shah, Samir S.; Ebberson, Jessica; Kestenbaum, Lori A.; Hodinka, Richard L.; Zorc, Joseph J.

doi:10.1002/jhm.711

Cited by 50 publications

(28 citation statements)

References 19 publications

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“…In studies that have excluded infants with "traumatic taps" (or nonbacterial illnesses), the mean number of white blood cells in uninfected preterm or term infants was consistently <10 cells/mm 3 . [44][45][46][47][48][49][50] Cell counts 2 standard deviations from the mean were generally less than 20 cells/mm 3 . 46 In a study by Garges et al, the median number of white blood cells in infants who were born at greater than 34 weeks' gestation and had bacterial meningitis was 477/mm 3 .…”

Section: Lumbar Puncturementioning

confidence: 91%

“…55 Protein concentrations in uninfected, term newborn infants are <100 mg/ dL. [44][45][46][47][48][49][50] Preterm infants have CSF protein concentrations that vary inversely with gestational age. In the normoglycemic newborn infant, glucose concentrations in CSF are similar to those in older infants and children (70%-80% of a simultaneously obtained blood specimen).…”

Section: Lumbar Puncturementioning

confidence: 99%

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Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Polin¹,

Newborn²

2012

Pediatrics

682

433

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With improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. The identification of neonates at risk for early-onset sepsis is frequently based on a constellation of perinatal risk factors that are neither sensitive nor specific. Furthermore, diagnostic tests for neonatal sepsis have a poor positive predictive accuracy. As a result, clinicians often treat well-appearing infants for extended periods of time, even when bacterial cultures are negative. The optimal treatment of infants with suspected early-onset sepsis is broad-spectrum antimicrobial agents (ampicillin and an aminoglycoside). Once a pathogen is identified, antimicrobial therapy should be narrowed (unless synergism is needed). Recent data suggest an association between prolonged empirical treatment of preterm infants (≥5 days) with broad-spectrum antibiotics and higher risks of late onset sepsis, necrotizing enterocolitis, and mortality. To reduce these risks, antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low. The purpose of this clinical report is to provide a practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis. Pediatrics

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Section: Lumbar Puncturementioning

confidence: 91%

Section: Lumbar Puncturementioning

confidence: 99%

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Polin¹,

Newborn²

2012

Pediatrics

682

433

View full text Add to dashboard Cite

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“…55 The CSF protein concentration in the term uninfected infant is usually less than 100 mg/dL; the CSF protein concentration of the uninfected preterm infant is higher than the term infant and is correlated with prematurity. 56 The CSF glucose concentration in the term infant is usually between 70% and 80% of a simultaneously measured serum glucose; a low CSF glucose has the greatest specificity for bacterial meningitis. 37,57 Bacterial meningitis may occur in infants with normal CSF parameters who concomitantly have a high concentration of bacterial organism.…”

Section: Csf Cell Count and Chemistriesmentioning

confidence: 99%

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

2013

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The definition of neonatal sepsis is complicated by the frequent presence of noninfectious conditions that resemble those of sepsis, especially in very low-birth-weight (VLBW) preterm infants and by the absence of optimal diagnostic tests. Although growth of an organism from a sterile site is the "gold standard" for definitive diagnosis, it is not always possible to isolate a causative pathogen. Invasive infections can occur in seemingly asymptomatic neonates. Therefore, assessment of history and risk factors in combination with diagnostic tests are used to identify neonates who are more likely to be infected.The definitions of early onset sepsis (EOS) and late onset sepsis (LOS) are subject to subspecialist variation. Many investigators, including those who participate in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Network and the Vermont Oxford Network, define EOS by the onset of signs/symptoms and an associated positive culture at or before 72 hours of life. LOS is characterized by the onset of symptoms consistent with sepsis at greater than 72 hours of life. These classifications of EOS and LOS reflect the differing etiologies and proposed pathophysiology of pathogens commonly associated with the timing of Keywords ► neonatal sepsis ► invasive candidiasis ► epidemiology ► management AbstractIdentifying neonates with sepsis is complicated by variability in clinical presentation. The incidence of early onset sepsis (EOS) resulting from invasive group B streptococcal (GBS) infections has been notably reduced by the widespread delivery of intrapartum antibiotic prophylaxis. Rates of EOS attributable to non-GBS etiologies have remained constant, and ampicillin-resistant Escherichia coli has become more prevalent. Lateonset sepsis (LOS) attributable to gram-positive organisms including coagulase-negative Staphylococci and Staphylococcus aureus is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of LOS, especially among infants who receive broad-spectrum antimicrobial agents. Prophylactic fluconazole administration to very low-birth-weight (VLBW) neonates during the first 6 weeks of life prevents invasive candidiasis in neonatal intensive care units (NICU) with high rates of fungal infections. Targeted fluconazole prophylaxis may be beneficial in VLBW neonates who receive care in NICUs with lower rates of invasive fungal infections. Assessment of immune function, neutrophil markers, acute phase reactants, and utilization of sepsis screening scores may contribute to the management of sepsis. Maternal decolonization, antimicrobial stewardship, early enteral feeding, and optimal infection control practices are potential practical strategies for reducing the burden of neonatal sepsis.

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“…4 The interpretation of CSF protein levels is further complicated in the youngest infants due to both the changing composition of the CSF as well as the higher rates of traumatic LPs. 5 Therefore, studies establishing a correction factor, adjusting observed CSF protein levels for the presence of CSF RBCs, that included predominantly older children may not be generalizable to neonates and young infants. 6 We sought to determine the relationship between CSF RBC count and CSF protein in infants 56 days of age who underwent LP in the emergency department (ED).…”

Section: Discussionmentioning

confidence: 99%

Adjustment of cerebrospinal fluid protein for red blood cells in neonates and young infants

Hines

Nigrovic

Neuman

et al. 2012

Journal of Hospital Medicine

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OBJECTIVE:To determine the relationship between cerebrospinal fluid (CSF) red blood cell (RBC) count and CSF protein in neonates and young infants undergoing lumbar puncture.DESIGN:Cross‐sectional study.SETTING:Urban tertiary care children's hospital.PATIENTS:Infants 56 days of age and younger who had a lumbar puncture in the emergency department between January 1, 2005 and July 31, 2009 were eligible for inclusion. Infants with missing laboratory data, exceedingly high CSF red blood cell counts, or conditions known to elevate CSF protein were excluded.MEASUREMENTS:Linear regression was used to determine the association between CSF RBC and CSF protein.RESULTS:Of 1986 infants, 56 days of age or younger, who underwent lumbar puncture in the emergency department during the study period, 1241 (62.5%) met inclusion criteria. The median age was 34 days (interquartile range: 19‐46 days); 45% of patients were male. The median CSF RBC count was 40 cells/mm3 (interquartile range: 2‐1080 cells/mm3); 11.8% of patients had a CSF RBC >10,000 cells/mm3. CSF protein increased by 1.9 mg/dL (95% confidence interval: 1.7‐2.1 mg/dL) per 1000 CSF RBCs for all included patients. Restricting analysis to patients without pleocytosis yielded comparable results, as did subanalyses by age and delivery type.CONCLUSIONS:We found that CSF protein concentrations increased by approximately 2 mg/dL for every 1000 CSF RBCs. These data may assist clinicians in interpreting CSF protein concentrations in infants 56 days of age and younger in the context of traumatic lumbar punctures. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

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Age‐specific reference values for cerebrospinal fluid protein concentration in neonates and young infants

Cited by 50 publications

References 19 publications

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

Adjustment of cerebrospinal fluid protein for red blood cells in neonates and young infants

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