Cerebrospinal fluid values in the very low birth weight infant A d i b F. R o d r i g u e z , MD, S h e l d o n L. K a p l a n , MD, a n d E d w a r d O. M a s o n Jr., PhD From the Myers-Black Infectious Disease Section, Department of Pediatrics, Baylor College of Medicine, and the Charles T. Parker Memorial Laboratory, Texas Children's Hospital, Houston, Texas
The cerebrospinal fluid values obtained in the first 12 weeks of life from 43 infants with birth weights of 1500 gm or less were a n a l y z e d to determine the ranges for leukocyte count and chemistry values. All these neonates had birth weights appropriate for gestational age, negative cerebrospinal fluid culture for bacteria, and no evidence of intracranial bleeding by head ultrasound examination. The mean birth weight was 1002 gm (range 550 to 1500 gm), and mean gestational a g e was 27 weeks (range 24 to 33 weeks). The mean cerebrospinal fluid leuko-. cyte count was 5 cells/mm s (range 0 to 44 cells/mm3); leukocyte differential was 7% polymorphonuclear leukocytes (range up to 66%) and 85% mononuclear leukocytes (range 13% to 100%). Additional values included protein concentration, 142 mg/dl (range 45 to 370 mg/dl); and glucose, 60 mg/dl (range 29 to 217 mg/dl). Knowledge of these measurements should help in the interpretation of the cerebrospinal fluid values of the very low birth weight infant undergoing examination of a central nervous system disorder. (J PEDIATR1990;116:971-4)
Very low birth weight infants are at risk for the development of serious systemic infections. Analysis of cerebrospinal fluid is an essential part of the evaluation of suspected infection, thus there is a need to know the normal chemical values and changes of the leukocyte count in this group of infants. This study presents the findings, from 43 infants with birth weights of 1500 gm or less who were being examined for suspected infection, of 71 CSF specimens obtained in the first 12 weeks of life. These infants had birth weights appropriate for gestational age, no evidence of intracranial bleeding by ultrasonography of the head, and bacteriologically sterile CSF cultures. METHODS One of the investigators (A. F. R.) identified twice a week all the VLBW infants admitted to the neonatal intensive Submitted for publication Oct. 23, 1989; accepted Dec. 21, 1989. Reprint requests: Sheldon L. Kaplan, MD, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. 9/23/18923
care unit of Texas Children's Hospital who had undergone a lumbar puncture during the first 12 weeks of life. Between July 1, 1988, and June 30, 1989 (excluding September and October 1988 and March and April 1989), 64 preterm infants with birth weights of -- 0.05); MN, mononuclear. *Number of CSF specimens.
T a b l e IIA. C S F values in V L B W infants, by chronologic age: Group 1 (birth weight _< 1000 gm) Postnatal a g e (days) 0-7 (6 infants; n = 6 ~) M e a n .+ SD Birth weight (gm) Gestational age at birth (wk) Leukocytes/rnm3 Erythrocytes/mm3 PMN (%) Glucose (mg/dl) Protein (mg/dl)
822 26 3 335 11 70 162
Range
• 116 _+ 1.2 • 3 • 709 _+ 20 .+ 17 .+ 37
630-980 24-27 1-8 0-1780 0-50 41-89 115-222
8-28 (42 infants; n=t7) M e a n • SD 752 26 4 1465 8 68 159
Range
• 112 • 1.5 ___4 • 4062 • 17 • 48 • 77
550-970 24-28 0-14 0-19,050 0-66 33-217 95-370
29-84 (40 infants; n=45) M e a n • SD 750 26 4 808 2 49 137
• • • • • • •
Range
120 1.0 3 1843 9 22 61
550-907 24-27 0-11 0-6850 0-36 29-90 76-260
*Number of CSF specimens.
Table liB. C S F values in V L B W infants, by chronologic age: Group 2 (birth weight _> 1001 to 1500 gin) Postnatal a g e (days) 0-7 (8 infants; n =
M e a n _ SD Birth weight (gin) Gestational age at birth (wk) leukocytes/mm3 Erythrocytes/rnm3 PMN (%) Glucose (mg/dl) Protein (mg/dl)
1428 31 4 407 4 74 t36
_+ 107 _+ 1.5 _+ 4 • 853 _+ 10 ,+ 19t • 35
8-28 (11 infants;
8")
n =
Range 1180-1500 28-33 1-10 0-2450 0-28 50-96 85-176
M e a n • SD 1245 29 7 1101 10 59 137
• 162 • 1.2 • 11 ___ 2643 • 19 • 23 • 46
29-84 (6 infants;
14)
n =
Range 1020-1480 27-31 0-44 0-9750 0-60 39-109 54-227
M e a n • SD 1211 29 8 661 11 47 122
_+ 86 • 0.7 + 8 _+ 1198 _+ 19 • 13 • 47
44)
Range 1080-1300 27-29 0-23 0-3800 0-48 31-76 45-187
*Number of CSF specimens. ~'p = 0.004. Infants up to 7 days of age had significantly higher value compared with those older than 29 days.
O f the 64 infants, 21 were excluded because of the
tococcusfaecalis septicemia and a C S F leukocyte count of
following: intraventricular hemorrhage with brain infarc-
100 cells/ram 3 (79% polymorphonuelear leukocytes). The
tion, 10; intraventricular hemorrhage and Escherichia coli meningitis, one; small for gestational age, five; congenital
other had a gestational age of 23 weeks and a birth weight
hydrocephalus, one; cystic leukomalacia in the periventricular area, one; and positive urine culture for cytomegalovirus, one. Two other infants were excluded: one had Strep-
of 630 gin; the first lumbar puncture, done at 12 days of life because of unexplained hyperglycemia, showed a leukocyte count of 192 c e l l s / m m 3 and protein concentration of 439 m g / d l ; blood and C S F bacterial cultures were negative. We
Volume 116 Number 6
C S F values in the V L B W infant
973
T a b l e III. C S F values in V L B W infants, by postconceptional age
Postconceptional age (wk)
CSF leukocytes/mm 3 • (range)
PMN (%) __+SD (range)
Glucose (mg/dl) • SD (range)
Protein (mg/dl) • SD (range)
26-28 29-31 32-34 35-37 38-40
6 5 4 6 9
6 10 4 5 16
85 54 55 56 44
177 144 142 109 117
(n (n (n (n (n
= = = = =
17) 23) 18) 8) 5)
• • • • •
10 (0-44) 4 (0-14) 3 (1-11) 7 (2222) 9 (0-23)
• • • • •
13 l9 11 14 23
(0-50) (0-66) (0-36) (0-40) (0-48)
• • • • •
39* (41-217) 18 (33-94) 21 (29-109) 21 (31-90) 10 (32-57)
• • • • •
60t (108-370) 40 (84-227) 49 (54-260) 53 (45-187) 33 (67-148)
n, Number of CSF specimens. *Group at 26 to 28 weeks had significantlygreater glucose and protein than the other four groups (p _< 0.04).
T a b l e IV. Comparison of C S F values in the V L B W infant with _< 1000 and > 1000 e r y t h r o c y t e s / m m 3
Erythrocytes/mm 3 _< t 0 0 0 (n = 57) Mean • SD Leukocytes/mm s Erythrocytes/mm 3 P M N (%) Glucose (mg/dl) Protein (mg/dl)
4 77 5 58 140
• 4 _+ 146 • 14 _+ 24 _+ 60
Erythrocytes/mm 3 > t 0 0 0 (n = 14)
Range
Mean • SD
0-23 0-995 0-87 29-109 45-370
9 4327 17 69 151
Range
_+ 12 _+ 9847 • 21 • 47 • 42
0-44 1030-19050 0-60 31-217 71-227
NS 0.006 NS NS NS
n, Number of CSF specimens;NS, not significant (p >0.05).
T a b l e V. C S F analysis from previous studies in p r e m a t u r e infants with birth weight _
The cerebrospinal fluid values obtained in the first 12 weeks of life from 43 infants with birth weights of 1500 gm or less were a n a l y z e d to determine the ranges for leukocyte count and chemistry values. All these neonates had birth weights appropriate for gestational age, negative cerebrospinal fluid culture for bacteria, and no evidence of intracranial bleeding by head ultrasound examination. The mean birth weight was 1002 gm (range 550 to 1500 gm), and mean gestational a g e was 27 weeks (range 24 to 33 weeks). The mean cerebrospinal fluid leuko-. cyte count was 5 cells/mm s (range 0 to 44 cells/mm3); leukocyte differential was 7% polymorphonuclear leukocytes (range up to 66%) and 85% mononuclear leukocytes (range 13% to 100%). Additional values included protein concentration, 142 mg/dl (range 45 to 370 mg/dl); and glucose, 60 mg/dl (range 29 to 217 mg/dl). Knowledge of these measurements should help in the interpretation of the cerebrospinal fluid values of the very low birth weight infant undergoing examination of a central nervous system disorder. (J PEDIATR1990;116:971-4)
Very low birth weight infants are at risk for the development of serious systemic infections. Analysis of cerebrospinal fluid is an essential part of the evaluation of suspected infection, thus there is a need to know the normal chemical values and changes of the leukocyte count in this group of infants. This study presents the findings, from 43 infants with birth weights of 1500 gm or less who were being examined for suspected infection, of 71 CSF specimens obtained in the first 12 weeks of life. These infants had birth weights appropriate for gestational age, no evidence of intracranial bleeding by ultrasonography of the head, and bacteriologically sterile CSF cultures. METHODS One of the investigators (A. F. R.) identified twice a week all the VLBW infants admitted to the neonatal intensive Submitted for publication Oct. 23, 1989; accepted Dec. 21, 1989. Reprint requests: Sheldon L. Kaplan, MD, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. 9/23/18923
care unit of Texas Children's Hospital who had undergone a lumbar puncture during the first 12 weeks of life. Between July 1, 1988, and June 30, 1989 (excluding September and October 1988 and March and April 1989), 64 preterm infants with birth weights of -- 0.05); MN, mononuclear. *Number of CSF specimens.
T a b l e IIA. C S F values in V L B W infants, by chronologic age: Group 1 (birth weight _< 1000 gm) Postnatal a g e (days) 0-7 (6 infants; n = 6 ~) M e a n .+ SD Birth weight (gm) Gestational age at birth (wk) Leukocytes/rnm3 Erythrocytes/mm3 PMN (%) Glucose (mg/dl) Protein (mg/dl)
822 26 3 335 11 70 162
Range
• 116 _+ 1.2 • 3 • 709 _+ 20 .+ 17 .+ 37
630-980 24-27 1-8 0-1780 0-50 41-89 115-222
8-28 (42 infants; n=t7) M e a n • SD 752 26 4 1465 8 68 159
Range
• 112 • 1.5 ___4 • 4062 • 17 • 48 • 77
550-970 24-28 0-14 0-19,050 0-66 33-217 95-370
29-84 (40 infants; n=45) M e a n • SD 750 26 4 808 2 49 137
• • • • • • •
Range
120 1.0 3 1843 9 22 61
550-907 24-27 0-11 0-6850 0-36 29-90 76-260
*Number of CSF specimens.
Table liB. C S F values in V L B W infants, by chronologic age: Group 2 (birth weight _> 1001 to 1500 gin) Postnatal a g e (days) 0-7 (8 infants; n =
M e a n _ SD Birth weight (gin) Gestational age at birth (wk) leukocytes/mm3 Erythrocytes/rnm3 PMN (%) Glucose (mg/dl) Protein (mg/dl)
1428 31 4 407 4 74 t36
_+ 107 _+ 1.5 _+ 4 • 853 _+ 10 ,+ 19t • 35
8-28 (11 infants;
8")
n =
Range 1180-1500 28-33 1-10 0-2450 0-28 50-96 85-176
M e a n • SD 1245 29 7 1101 10 59 137
• 162 • 1.2 • 11 ___ 2643 • 19 • 23 • 46
29-84 (6 infants;
14)
n =
Range 1020-1480 27-31 0-44 0-9750 0-60 39-109 54-227
M e a n • SD 1211 29 8 661 11 47 122
_+ 86 • 0.7 + 8 _+ 1198 _+ 19 • 13 • 47
44)
Range 1080-1300 27-29 0-23 0-3800 0-48 31-76 45-187
*Number of CSF specimens. ~'p = 0.004. Infants up to 7 days of age had significantly higher value compared with those older than 29 days.
O f the 64 infants, 21 were excluded because of the
tococcusfaecalis septicemia and a C S F leukocyte count of
following: intraventricular hemorrhage with brain infarc-
100 cells/ram 3 (79% polymorphonuelear leukocytes). The
tion, 10; intraventricular hemorrhage and Escherichia coli meningitis, one; small for gestational age, five; congenital
other had a gestational age of 23 weeks and a birth weight
hydrocephalus, one; cystic leukomalacia in the periventricular area, one; and positive urine culture for cytomegalovirus, one. Two other infants were excluded: one had Strep-
of 630 gin; the first lumbar puncture, done at 12 days of life because of unexplained hyperglycemia, showed a leukocyte count of 192 c e l l s / m m 3 and protein concentration of 439 m g / d l ; blood and C S F bacterial cultures were negative. We
Volume 116 Number 6
C S F values in the V L B W infant
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T a b l e III. C S F values in V L B W infants, by postconceptional age
Postconceptional age (wk)
CSF leukocytes/mm 3 • (range)
PMN (%) __+SD (range)
Glucose (mg/dl) • SD (range)
Protein (mg/dl) • SD (range)
26-28 29-31 32-34 35-37 38-40
6 5 4 6 9
6 10 4 5 16
85 54 55 56 44
177 144 142 109 117
(n (n (n (n (n
= = = = =
17) 23) 18) 8) 5)
• • • • •
10 (0-44) 4 (0-14) 3 (1-11) 7 (2222) 9 (0-23)
• • • • •
13 l9 11 14 23
(0-50) (0-66) (0-36) (0-40) (0-48)
• • • • •
39* (41-217) 18 (33-94) 21 (29-109) 21 (31-90) 10 (32-57)
• • • • •
60t (108-370) 40 (84-227) 49 (54-260) 53 (45-187) 33 (67-148)
n, Number of CSF specimens. *Group at 26 to 28 weeks had significantlygreater glucose and protein than the other four groups (p _< 0.04).
T a b l e IV. Comparison of C S F values in the V L B W infant with _< 1000 and > 1000 e r y t h r o c y t e s / m m 3
Erythrocytes/mm 3 _< t 0 0 0 (n = 57) Mean • SD Leukocytes/mm s Erythrocytes/mm 3 P M N (%) Glucose (mg/dl) Protein (mg/dl)
4 77 5 58 140
• 4 _+ 146 • 14 _+ 24 _+ 60
Erythrocytes/mm 3 > t 0 0 0 (n = 14)
Range
Mean • SD
0-23 0-995 0-87 29-109 45-370
9 4327 17 69 151
Range
_+ 12 _+ 9847 • 21 • 47 • 42
0-44 1030-19050 0-60 31-217 71-227
NS 0.006 NS NS NS
n, Number of CSF specimens;NS, not significant (p >0.05).
T a b l e V. C S F analysis from previous studies in p r e m a t u r e infants with birth weight _
