Cerebrospinal fluid values in the term neonate

Ahmed, Amina; Hickey, Sheila; Ehrett, Stuart; Trujillo, Mónica; Brito, Fanny; Goto, Colin; Olsen, Kurt; Krisher, Karen; McCracken, George H.

doi:10.1097/00006454-199604000-00004

Cited by 86 publications

(59 citation statements)

References 17 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: 92%

“…[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 . 43 In contrast, the median number of white blood cells in infants who were born at less than 34 weeks' gestation and had meningitis was 110/mm 3 .…”

Section: Lumbar Puncturementioning

confidence: 92%

“…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

661

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: 92%

Section: Lumbar Puncturementioning

confidence: 92%

Section: Lumbar Puncturementioning

confidence: 99%

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

Polin¹,

Newborn²

2012

Pediatrics

661

433

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“…In our comparison of CSF parameters in culture-positive and culture-negative specimens obtained from IVR, we found a considerable overlap with values beyond the 'conventional norms' even in the absence of infection. [16][17][18] The CSF WBC count that is most frequently used to diagnose infection before the culture results become available did not vary significantly between the two groups. However, we did find a significant increase in the percentage of CSF neutrophils and a decrease in the ratio of CSF and serum glucose in culturepositive specimens.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of cerebrospinal fluid parameters in preterm infants with intraventricular reservoirs

2012

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Objective: Intraventricular reservoirs (IVRs) are used to drain cerebrospinal fluid (CSF) in neonates with post-hemorrhagic ventricular dilatation (PHVD). The objectives of this case-control study were to evaluate changes in CSF parameters in serial IVR taps and to compare CSF parameters in culture-positive and -negative specimens.Study Design: Clinical and laboratory data from serial (up to 7) reservoir taps at 5-to 8-day intervals were collected on preterm neonates with PHVD and IVR insertion. Result:The median (range) gestational age and birth weight of our cohort (n ¼ 52) was 26 (23 to 33) weeks and 796 (450 to 1620) grams. Significant decreases in percentage of CSF neutrophils and protein were noted in later taps, compared with the first tap at insertion of IVR. Five (9.6%) infants had positive CSF cultures on 10 occasions. Compared with negative specimens (n ¼ 266), the mean (s.d.) proportion of neutrophils in CSF (55% (33) vs 26% (23)) was significantly higher and ratio of CSF to serum glucose significantly lower (0.19 (0.08) vs 0.29 (0.13)) in culture-positive specimens (n ¼ 10). The area under the curve was 0.82 (95% confidence interval (CI) 0.72 to 0.93) for CSF white blood cell (WBC) count, 0.79 (95% CI 0.68 to 0.90) for CSF protein and 0.75 (95% CI 0.56 to 0.95) for percentage of neutrophils. The sensitivities and specificities for diagnosis of infection was 90 and 63% for CSF WBC count > 42 mm -3 , 89 and 58% for CSF protein at > 250mg dl -1 and 80 and 67% for CSF neutrophil proportion >31.5%.Conclusion: CSF parameters from IVR taps, specifically proportion of neutrophils and proteins are higher at insertion and progressively normalize over time. Although they vary widely, CSF WBC, protein and neutrophil proportion using higher cut-off values have good sensitivity in the diagnosis of infection.

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“…(Portnoy and Olson 1985) Ahmed et al found a mean of 7.3 WBC/mm 3 in non-infected neonates, with a range of 0 -130/mm 3 . (Ahmed, Hickey et al 1996) (Shah, Shofer et al 2005) Other authors have noted a wide variability of CSF cell counts in children with or without infection. (Garges, Moody et al 2006) The presence of a shunt may alter the chemistry and cell levels.…”

Section: Csf Cell Counts In Children With Shuntsmentioning

confidence: 99%