Table 8.12Evidence profile for cerebrospinal fluid analysis in babies about to start antibiotic treatment

Number of studiesNumber of babiesSensitivity (95% confidence interval)Specificity (95% confidence interval)Positive likelihood ratio (95% confidence interval)Negative likelihood ratio (95% confidence interval)Quality
Presence of any WBC in CSF (that is, CSF WBC count >0 cells/mm3) in the prediction of meningitis in the first week of life, using CSF culture as reference standard
1
(Garges 2006)
9,11197 (88 to 99)11 (10 to 12)1.09 (1.03 to 1.14)0.3 (0.08 to 1.22)Very low
CSF WBC > 21 cells/mm3 to predict bacterial meningitis in the first week of life, using CSF culture as reference standard
1
(Garges 2006)
9,11179 (67 to 89)81 (80 to 82)4 (4 to 5)0.3 (0.2 to 0.4)Very low
Elevated CSF WBC count (defined as WBC ≥ 23 or ≥ 26 cells/mm3 for babies ≥ 37 or < 37 weeks’ gestation, respectively) to predict bacterial meningitis in the first week of life, using CSF culture as reference standard
1
(Ansong 2009)
13,495898250.1Very low
CSF protein of 41–90 mg/dl to predict bacterial meningitis in the first week of life, using CSF culture as reference standard
1
(Garges 2006)
9,111100 (84 to 100)2 (1 to 3)11.0Very low
CSF protein of 90–120 mg/dl to predict bacterial meningitis in the first week of life, using CSF culture as reference standard
1
(Garges 2006)
9,11184 (71 to 92)28 (27 to 29)10.9Very low
Elevated CSF protein (defined as protein ≥ 171 or ≥ 151 mg/dl for babies ≥ 37 or < 37 weeks’ gestation, respectively) to predict bacterial meningitis in the first week of life, using CSF culture as reference standard
1
(Ansong 2009)
13,495937640.1Very low
Low CSF glucose (defined as glucose ≤ 33 or ≤ 23 mg/dl for babies ≥ 37 or < 37 weeks’ gestation, respectively) to predict bacterial meningitis in the first week of life, using CSF culture as reference standard
1
(Ansong 2009)
13,4956196140.4Very low
CSF glucose < 20 mg/dl to predict bacterial meningitis in the first week of life, using CSF culture as reference standard
1
(Garges 2006)
9,11144 (30 to 58)98 (97 to 99)10.9Very low
CSF glucose of 20–60 mg/dl to predict bacterial meningitis in the first week of life, using CSF culture as reference standard
1
(Garges 2006)
9,11189 (78 to 96)20 (18 to 21)10.9Very low
CSF glucose > 120 mg/dl to predict bacterial meningitis in the first week of life, using CSF culture as reference standard
1
(Garges 2006)
9,11176 (63 to 87)63 (62 to 64)20.5Very low
Composite measure based on any abnormal CSF value (that is, any of WBC ≥ 23 or ≥ 26 cells/mm3 or protein ≥ 171 or ≥ 151 mg/dl or glucose ≤ 33 or ≤ 23 mg/dl for babies ≥ 37 or < 37 weeks’ gestation, respectively) to predict bacterial meningitis in the first week of life, using CSF culture as reference standard
1
(Ansong 2009)
13,495976730.1Very low
Composite measure based all CSF value being abnormal (that is, all of: WBC ≥ 23 or ≥ 26 cells/mm3 or protein ≥ 171 or ≥ 151 mg/dl or glucose ≤ 33 or ≤ 23 mg/dl for babies ≥ 37 or < 37 weeks’ gestation, respectively) to predict bacterial meningitis in the first week of life, using CSF culture as reference standard
1
(Ansong 2009)
13,4955898320.4Very low

CSF cerebrospinal fluid, NC not calculable, WBC white blood cell

See the complete GRADE Table J 8.12

From: 8, Investigations before starting antibiotics in the baby

Cover of Antibiotics for Early-Onset Neonatal Infection
Antibiotics for Early-Onset Neonatal Infection: Antibiotics for the Prevention and Treatment of Early-Onset Neonatal Infection.
NICE Clinical Guidelines, No. 149.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Aug.
Copyright © 2012, National Collaborating Centre for Women’s and Children’s Health.

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