Cerebrospinal fluid reference ranges in term and preterm infants in the neonatal intensive care unit

Abstract

Objective: To determine reference ranges of cerebrospinal fluid (CSF) laboratory findings in term and preterm infants in the neonatal intensive care unit.

Study design: Data were collected prospectively as part of a multisite study of infants aged <6 months undergoing lumbar puncture for evaluation of suspected sepsis. Infants with a red blood cell count >500 cells/μL or a known cause of CSF pleocytosis were excluded from the analysis.

Results: A total of 318 infants met the inclusion criteria. Of these, 148 infants (47%) were preterm, and 229 (72%) received antibiotics before undergoing lumbar puncture. The upper reference limit of the CSF white blood cell (WBC) count was 12 cells/μL in preterm infants and 14 cells/μL in term infants. CSF protein levels were significantly higher in preterm infants (upper reference limit, 209 mg/dL vs 159 mg/dL in term infants; P < .001), and declined with advancing postnatal age in both groups (preterm, P = .008; term, P < .001). CSF glucose levels did not differ in term and preterm infants. Antibiotic exposure did not significantly affect CSF WBC, protein, or glucose values.

Conclusions: CSF WBC counts are not significantly different in preterm and term infants. CSF protein levels are higher and decline more slowly with postnatal age in preterm infants compared with term infants. This study provides CSF reference ranges for hospitalized preterm and term infants, particularly in the first month of life.

Figure

Changes in A and D, CSF WBC count (A and D), CSF protein level C and F, and CSF glucose level with increasing postnatal age in preterm and term infants. The graphs exclude infants with unknown CSF WBC concentration (n = 1) or an extremely outlying value (n = 1; CSF WBC of 850), unknown CSF protein concentration (n = 4), and unknown CSF glucose concentration (n = 2). The solid lines represent the best linear fit for each laboratory test result; the dashed lines represent upper limits (for CSF WBC and protein) and lower limits (for CSF glucose) based on the addition or subtraction of 1.5 × IQR to the upper or lower limit of the IQR, respectively; and the dotted lines represent upper limits (for CSF WBC and protein) and lower limits (for CSF glucose) based on the 95th and 5th percentile values, respectively. The vertical line represents a postnatal age of 7 days.