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Determining Normative Values for Cerebrospinal Fluid Profiles in Infants

Gargi Mukherjee1, Rabbia Waris2, Willi Rechler3

  • 1Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia gmukher@emory.edu.

Hospital Pediatrics
|August 4, 2021
PubMed

Insights

This study established age-specific reference values for cerebrospinal fluid (CSF) profiles in infants up to 90 days old. Findings reveal distinct CSF white blood cell counts, protein, and glucose levels that change with infant age.

Area of Science:

  • Pediatric Neurology
  • Clinical Chemistry
  • Neonatology

Background:

  • Previous cerebrospinal fluid (CSF) reference value studies lacked sufficient sample size and rigorous exclusion criteria.
  • Establishing accurate normative CSF profiles is crucial for diagnosing infections and neurological conditions in infants.

Purpose of the Study:

  • To determine age-specific normative values for CSF white blood cell count (WBC), glucose, and protein in infants up to 90 days old.
  • To provide updated reference ranges for pediatric CSF analysis.

Main Methods:

  • Retrospective cross-sectional study of 1029 infants ≤90 days old undergoing diagnostic lumbar puncture (2008-2016).
  • Strict exclusion criteria were applied, including meningitis, bacteremia, UTI, HSV PCR positivity, traumatic taps, prematurity, and recent antibiotic use.
  • CSF WBC, differential, protein, glucose, and enterovirus PCR data were analyzed and compared across age groups (0-28, 29-60, 61-90 days).

Main Results:

  • CSF white blood cell (WBC) counts were significantly higher in neonates (0-28 days) compared to older infants (29-90 days) (median 3 vs. 2; 95th percentile 14 vs. 7-11).
  • CSF protein levels significantly decreased, while glucose levels significantly increased with each month of infant age.
  • Monocytes were the predominant cell type in the CSF WBC differential for the studied infant population.

Conclusions:

  • Age-specific normative CSF profile values were successfully determined for infants aged 0 to 90 days.
  • These findings provide essential reference ranges for the interpretation of CSF analysis in young infants.
  • The study highlights the dynamic changes in CSF composition during early infancy.
Abstract

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