Normal cerebrospinal fluid values in full-term gestation and premature neonates

Abstract

-Results of cerebrospinal fluid (CSF) examinations from 77 high-risk neonates were reviewed. The mean CSF white cells (WBC) count was 4.5 cell/mm 3 , being two standard deviations above the mean 11.7 cells/ mm 3 in the full-term gestation neonate group; in the premature neonate one, the mean CSF WBC count was 5.1 cells/mm 3 , being two standard deviations above the mean 16.7 cell/mm 3 . PMNs (polymorphonuclear leukocytes) were present in less than 40% of those children, being the mean PMN percentage 4.2% and 0.6%, the mean ANC (absolute neutrophil count) was 0.3/mm 3 and 0.06/mm 3 , in full-term gestation neonate group and premature neonate one, respectively. The mean CSF protein concentration is significantly greater in those premature neonates (101.2 mg/dl) compared with that in term neonates (77.6 mg/dl). The average glucose was just the same in both groups (67 mg/dl). All of these values were from patients who underwent nontraumatic cisternal puncture, with no red blood cells (RBC/mm 3 =0). Traumatic puncture, even up to 500 RBC/mm 3 , interfered on CSF parameters.KEY WORDS: cerebrospinal fluid, neonate, cisternal puncture, normal values. Valores normais do líquido cefalorraqueano em recém-nascidos a termo e prematurosRESUMO -Os resultados do estudo do líquido cefalorraqueano realizado em 77 recém-nascidos de alto risco foram revistos. A média da celularidade foi 4,5 células/mm 3 , sendo a soma da média mais 2 desvios-padrão 11,7 células/mm 3 no grupo de crianças a termo; no grupo de crianças prematuras, a média da celularidade foi 5,1 células/mm 3 , sendo a soma da média mais 2 desvios-padrão 16,7 células/mm3. Neutrófilos estavam presentes em menos de 40% dos exames, sendo a média do percentual de neutrófilos 4,2% e 0,6% e a média da contagem absoluta de neutrófilos 0,3/mm 3 e 0,06/mm 3 , no grupo de crianças a termo e no grupo de crianças prematuras, respectivamente. A média da proteína foi maior entre os prematuros (101,2 mg/dl) quando comparada com a média da proteína entre os recém-nascidos a termo (77,6 mg/dl), sendo a diferença estatisticamente significante. A média da glicose foi a mesma nos 2 grupos (67 mg/dl). Todos estes valores foram decorrentes da análise de exames sem acidente de punção (hemácias/mm 3 = 0). Acidente de punção, mesmo com hemácias < 500/mm 3 , interfere nos parâmetros do líquor. PALAVRAS-CHAVE: líquido cefalorraqueano, recém-nascido, punção cisternal, valores normais.Evaluation of the cerebrospinal fluid (CSF) white blood cell (WBC) count and glucose and protein concentrations is used to assess the probability of the presence of central nervous system (CNS) infection, mainly bacterial, viral and fungal meningitis 1,2 . Although normal values are well established for CSF cell counts and protein and glucose contents in children and adults, this is not the case for neonates 3,4 . Several studies have been conducted in order to determine the range of normal cellularity in noninfected CSF neonates but shortcomings of their methodology were: the inclusion of cases with traumat...

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

“…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 .…”

“…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).…”

Defining Cerebrospinal Fluid White Blood Cell Count Reference Values in Neonates and Young Infants

“…The initial search term was “cerebrospinal fluid,” which was then combined with “white blood cell” or “leukocytosis,” and either “neonate,” “infant” or “newborn.” Limits included “humans” and “English language.” Titles and abstracts of 300 articles were reviewed for relevance: 5 studies were found to be relevant 17, 21, 23, 25, 27. Nine additional studies were identified during review of the references of textbooks and published studies 14–16, 18–20, 22, 24, 26…”

“…However, few patients ≤56 days of age have been studied, and different ranges of reference values have been established as authors have used varying exclusion criteria. These past studies included children with traumatic lumbar puncture,14–20 seizures,17 sepsis,21 congenital infections19, 22 and very low birth weights 23…”

Neutrophils and red blood cells in the cerebrospinal fluid of newborns

“…The poor difference between the CSF parameters of premature and full‐term newborns was noteworthy. Nonetheless, we have previously demonstrated that only the mean percentage neutrophil count and the mean protein concentration were significantly different when CSF parameters from premature and full‐term newborns were compared (10). Regarding aging, the total WBC count and the protein concentration are expected to decrease as of 4 weeks of age among full‐term newborns (11).…”