Normal Values for Cerebrospinal Fluid in Neonates: A Systematic Review

Area of Science:

• Neonatal Medicine
• Neurology
• Clinical Diagnostics

Background:

• Cerebrospinal fluid (CSF) analysis is crucial for diagnosing neonatal meningitis.
• Normal CSF values in neonates are not well-established and vary with age.
• Previous studies often included infants with pre-treatment or unconfirmed viral meningitis.

Approach:

• Conducted a systematic literature search of MEDLINE and EMBASE databases.
• Included original studies on CSF normal values in healthy or reliably meningitis-excluded neonates.
• Analyzed data from 270 term and 96 preterm neonates across seven studies.

Key Points:

• Cerebrospinal fluid (CSF) white blood cell (WBC) count and glucose showed minimal differences between preterm and term neonates.
• CSF neutrophil count and protein concentration were influenced by gestational and chronological age.
• Specific 95th percentile values for CSF WBC, neutrophil count, and protein concentration were identified for term and preterm neonates.

Conclusions:

• Neonatal CSF normal ranges differ from older infants and are age-dependent.
• CSF parameters alone are not definitive for excluding meningitis.
• Gestational and chronological age impact CSF neutrophil count and protein levels.