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Pediatrics. 2018 Feb 2. pii: e20173405. doi: 10.1542/peds.2017-3405. [Epub ahead of print]

Cerebrospinal Fluid Reference Values for Young Infants Undergoing Lumbar Puncture.

Author information

1
Divisions of Hospital Medicine, joanna.thomson@cchmc.org.
2
Biostatistics and Epidemiology, and.
3
Sections of Emergency Medicine and Infectious Diseases, Baylor College of Medicine, Houston, Texas.
4
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
5
Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada.
6
Warren Alpert Medical School, Brown University, Providence, Rhode Island.
7
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
8
School of Medicine, University of Colorado, Aurora, Colorado.
9
Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
10
Departments of Emergency Medicine and Pediatrics, School of Medicine, University of California, San Diego and Rady Children's Hospital-San Diego, San Diego, California; and.
11
University of Toronto, Toronto, Canada.
12
Divisions of Hospital Medicine.
13
Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Abstract

OBJECTIVES:

To determine age-specific reference values and quantify age-related changes for cerebrospinal fluid (CSF) white blood cell (WBC) counts and protein and glucose concentrations in infants ≤60 days of age.

METHODS:

This multicenter, cross-sectional study included infants ≤60 days old with CSF cultures and complete CSF profiles obtained within 24 hours of presentation. Those with conditions suspected or known to cause abnormal CSF parameters (eg, meningitis) and those with a hospital length of stay of >72 hours were excluded. Reference standards were determined for infants ≤28 days of age and 29 to 60 days of age by using the third quartile +1.5 interquartile range for WBC and protein and the first quartile -1.5 interquartile range for glucose. CSF parameter centile curves based on age were calculated by using the LMST method.

RESULTS:

A total of 7766 patients were included. CSF WBC counts were higher in infants ≤28 days of age (upper bound: 15 cells/mm3) than in infants 29 to 60 days of age (upper bound: 9 cells/mm3; P < .001). CSF protein concentrations were higher in infants ≤28 days of age (upper bound: 127 mg/dL) than in infants 29 to 60 days of age (upper bound: 99 mg/dL; P < .001). CSF glucose concentrations were lower in infants ≤28 days of age (lower bound: 25 mg/dL) than in infants 29 to 60 days of age (lower bound: 27 mg/dL; P < .001).

CONCLUSIONS:

The age-specific CSF WBC count, protein concentration, and glucose concentration reference values identified in this large, multicenter cohort of infants can be used to interpret the results of lumbar puncture in infants ≤60 days of age.

PMID:
29437883
DOI:
10.1542/peds.2017-3405

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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