Cerebrospinal Fluid Reference Values for Young Infants Undergoing Lumbar Puncture

Area of Science:

• Pediatric Neurology
• Clinical Chemistry
• Neonatology

Background:

• Establishing accurate reference ranges for cerebrospinal fluid (CSF) parameters in neonates is crucial for diagnosing central nervous system infections and conditions.
• Existing CSF reference values in infants are often limited, necessitating age-specific data for precise interpretation.

Purpose of the Study:

• To determine age-specific reference values for CSF white blood cell (WBC) counts, protein, and glucose concentrations in infants up to 60 days of age.
• To quantify age-related changes in these CSF parameters within the first two months of life.

Main Methods:

• A multicenter, cross-sectional study involving 7766 infants ≤60 days old with complete CSF profiles.
• Exclusion criteria included conditions affecting CSF parameters and prolonged hospital stays (>72 hours).
• Reference standards were derived using quartile-based methods, and age-specific centile curves were generated using the LMST method.

Main Results:

• CSF white blood cell (WBC) counts were significantly higher in infants ≤28 days (upper bound: 15 cells/mm³) compared to those 29-60 days old (upper bound: 9 cells/mm³).
• CSF protein concentrations were also higher in the younger infant group (≤28 days: upper bound 127 mg/dL) versus the older group (29-60 days: upper bound 99 mg/dL).
• CSF glucose concentrations were lower in infants ≤28 days (lower bound: 25 mg/dL) than in infants 29-60 days old (lower bound: 27 mg/dL).

Conclusions:

• This study provides robust, age-specific reference values for CSF WBC count, protein, and glucose in infants up to 60 days.
• These established values are essential for accurate interpretation of lumbar puncture results in neonates and young infants.
• The findings support improved diagnostic accuracy for neurological conditions in this vulnerable population.