Meningitis in preterm neonates: importance of cerebrospinal fluid parameters.
Cerebrospinal fluid parameters are of great importance in diagnosing meningitis, but normal values for preterm neonates are based on small, single-center studies. We sought to determine current values for preterm neonate cerebrospinal fluid parameters and assess the association of cerebrospinal fluid parameters with culture proven meningitis. We performed a cohort study of the first lumbar puncture from 4632 neonates < 34 weeks' gestation performed in the years 1997 to 2004 at 150 neonatal intensive care units managed by the Pediatrix Medical Group. We identified 95 cases of meningitis from the 4632 lumbar punctures. The area under the receiver operating characteristic curves for white blood cell count, glucose, and protein were 0.80, 0.63, and 0.72, respectively, for prediction of culture-proven meningitis. Cerebrospinal fluid parameters used to diagnose meningitis in the absence of dependable cerebrospinal fluid cultures are unreliable. Caution should be employed when interpreting cerebrospinal fluid parameters in the premature neonate.
Smith
P Brian
PB
Department of Pediatrics, Duke University, Durham, North Carolina 27710, USA. brian.smith@duke.edu
Garges
Harmony P
HP
Cotton
C Michael
CM
Walsh
Thomas J
TJ
Clark
Reese H
RH
Benjamin
Daniel K
DK
D002556:Cerebrospinal Fluid Proteins; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000453:epidemiology*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007958:Leukocyte Count; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D013129:Spinal Puncture
D002556:Cerebrospinal Fluid Proteins; D005947:Glucose