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Age-specific reference values for cerebrospinal fluid protein concentrations in children in southern China
Zhigang Liu1, Deqin Jia, Jieming Dai
1Department of Pediatrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Guangdong, China.
Insights
This study establishes crucial cerebrospinal fluid (CSF) protein reference values for Chinese infants, detailing the normal decline after birth. These findings aid in interpreting lumbar puncture results for early life diagnostics.
Area of Science:
- Pediatrics
- Neurology
- Clinical Chemistry
Background:
- Cerebrospinal fluid (CSF) protein levels naturally decrease in infants as their blood-CSF barrier matures.
- Existing studies lack specific CSF protein reference values for Chinese infants and report varied decline rates.
- Accurate reference values are essential for diagnosing neurological conditions in infants.
Purpose of the Study:
- To determine age-specific reference intervals for CSF protein concentrations in southern Chinese infants.
- To quantify the decline in CSF protein levels during the first two years of life.
- To provide reliable data for interpreting lumbar puncture results in pediatric patients.
Main Methods:
- Retrospective analysis of 1043 infants who underwent lumbar puncture (LP) between 2008 and 2018.
- Exclusion of infants with conditions known to elevate CSF protein.
- Calculation of median and 95th percentile CSF protein values based on age groups.
Main Results:
- CSF protein concentration showed a significant age-related decline in infants up to two years old.
- Median CSF protein was 62 mg/dL (IQR: 47-81 mg/dL) for infants 0-56 days and 21 mg/dL (IQR: 16-31 mg/dL) for infants 2 months to <3 years.
- Specific 95th percentile values were provided for various age strata within the first six months and up to two years.
Conclusions:
- This study provides the first comprehensive reference intervals for CSF protein in southern Chinese infants.
- The established age-specific values facilitate accurate interpretation of LP results in infants.
- These findings contribute to improved diagnosis and management of pediatric neurological disorders.
Abstract:
Cerebrospinal fluid (CSF) protein values decline over the first few months of life as the infant's blood-CSF barrier matures. However, published studies have not reported CSF protein reference values of Chinese infants and differ in the reported rate, timing, and magnitude of this decline. The objective of this study was to determine reference intervals for CSF protein using available data of children in southern China. This retrospective study included infants who had a lumbar puncture (LP) performed in the Department of Pediatrics of Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan of an urban tertiary care children's hospital between January 1, 2008 and May 31, 2018. Infants with conditions suspected or known to cause elevated CSF protein concentrations were excluded. Of 3712 infants undergoing LP, 1043 (28.1%) met inclusion criteria. Results showed that there is an age-related decline in CSF protein concentration. The median CSF protein value was 62 mg/dL [interquartile range (IQR): 47-81 mg/dL] in infants aged 0 to 56 days (group 1). The 95th percentile values were 116 mg/dL for infants 0 to 28 days and 80 mg/dL for infants 29 to 56 days. The 95th percentile values by age category were as follows: ages 0 to 14 days, 117 mg/dL; ages 15 to 28 days, 107 mg/dL; ages 29 to 42 days, 96 mg/dL; and ages 43 to 56 days, 74 mg/dL. The median CSF protein value was 21 mg/dL (IQR: 16-31 mg/dL) in infants aged 2 months to <3 years (group 2). The 95th percentile values were 57 mg/dL for infants 2 to <6 months and 34 mg/dL for infants 6 to ≤24 months. The 95th percentile values by age category were as follows: ages 2 to <3 months, 66 mg/dL; ages 3 to <4 months, 52 mg/dL; ages 4 to <5 months, 53 mg/dL; and ages 5 to <6 months, 42 mg/dL. We quantify the age-related decline in CSF protein concentrations among infants 2 years of age and younger and provide age-specific reference values. The values reported here can be used to interpret the results of LP in infants ≤2 years of age.
