title: Adjustment of cerebrospinal fluid protein for red blood cells in neonates and young infants.
abstract: OBJECTIVE
  To determine the relationship between cerebrospinal fluid (CSF) red blood cell (RBC) count and CSF protein in neonates and young infants undergoing lumbar puncture.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Urban tertiary care children's hospital.
  
  
  METHODS
  Infants 56 days of age and younger who had a lumbar puncture in the emergency department between January 1, 2005 and July 31, 2009 were eligible for inclusion. Infants with missing laboratory data, exceedingly high CSF red blood cell counts, or conditions known to elevate CSF protein were excluded.
  
  
  METHODS
  Linear regression was used to determine the association between CSF RBC and CSF protein.
  
  
  RESULTS
  Of 1986 infants, 56 days of age or younger, who underwent lumbar puncture in the emergency department during the study period, 1241 (62.5%) met inclusion criteria. The median age was 34 days (interquartile range: 19-46 days); 45% of patients were male. The median CSF RBC count was 40 cells/mm(3) (interquartile range: 2-1080 cells/mm(3)); 11.8% of patients had a CSF RBC >10,000 cells/mm(3). CSF protein increased by 1.9 mg/dL (95% confidence interval: 1.7-2.1 mg/dL) per 1000 CSF RBCs for all included patients. Restricting analysis to patients without pleocytosis yielded comparable results, as did subanalyses by age and delivery type.
  
  
  CONCLUSIONS
  We found that CSF protein concentrations increased by approximately 2 mg/dL for every 1000 CSF RBCs. These data may assist clinicians in interpreting CSF protein concentrations in infants 56 days of age and younger in the context of traumatic lumbar punctures.
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Hines
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D015415:Biomarkers / Q000134:cerebrospinal fluid / Q000378:metabolism; D002556:Cerebrospinal Fluid Proteins / Q000134:cerebrospinal fluid*; D003430:Cross-Sectional Studies; D004906:Erythrocyte Count / Q000639:trends; D004912:Erythrocytes / Q000378:metabolism*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013129:Spinal Puncture / Q000639:trends
chemical_list: D015415:Biomarkers; D002556:Cerebrospinal Fluid Proteins