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Correction of Cerebrospinal Fluid Protein in Infants With Traumatic Lumbar Punctures
Todd W Lyons1, Andrea T Cruz, Stephen B Freedman
1From the *Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; †Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas; ‡Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; §Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota; ¶Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut; ‖Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; **Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; ††Department of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan; ‡‡Section of Pediatric Emergency Medicine, Children's Hospital Colorado, Aurora, Colorado; §§Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and ¶¶Departments of Pediatrics and Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
Insights
A traumatic lumbar puncture in infants under 60 days old occurred in 1.2% of cases, leading to bacterial meningitis. Cerebrospinal fluid protein levels correlate with red blood cell counts in these infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Traumatic lumbar punctures (TLPs) are common in neonates.
- Identifying infectious complications post-TLP is crucial for infant health.
- Cerebrospinal fluid (CSF) analysis aids in diagnosing meningitis.
Purpose of the Study:
- To determine the incidence of bacterial meningitis following traumatic lumbar puncture in young infants.
- To investigate the relationship between cerebrospinal fluid red blood cell counts and protein levels in this cohort.
Main Methods:
- Retrospective analysis of a multicenter cohort.
- Inclusion criteria: infants ≤60 days of age with a TLP.
- Data collected included TLP outcomes and CSF analysis results.
Main Results:
- Out of 2646 infants with TLP, 31 (1.2%) developed bacterial meningitis.
- A positive correlation was found between CSF red blood cells and CSF protein levels.
- For every 1000 CSF red blood cells/mm³, CSF protein increased by 1.1 mg/dL (95% CI: 1.0-1.2 mg/dL).
Conclusions:
- Bacterial meningitis is an uncommon but significant complication of traumatic lumbar puncture in young infants.
- Elevated cerebrospinal fluid protein in the context of red blood cells may indicate inflammation or contamination.
- Further research is warranted to refine diagnostic criteria for meningitis after TLP in neonates.
Abstract:
In our multicenter cohort of infants ≤60 days of age, we identified 2646 infants with a traumatic lumbar puncture, of which 31 (1.2%) had bacterial meningitis. For every 1000 cerebrospinal fluid red blood cells/mm, cerebrospinal (cerebrospinal fluid) protein increased 1.1 mg/dL (95% confidence interval: 1.0-1.2 mg/dL).
