LUMBAR PUNCTURE IN THE EVALUATION OF POSSIBLE ASYMPTOMATIC CONGENITAL-SYPHILIS IN NEONATES

Objective: To evaluate the usefulness of lumbar puncture (LP) in the i nitial evaluation of symptom-free infants for congenital syphilis. Stu dy design: We retrospectively studied infants who had successful LPs a nd were born to untreated or inadequately treated seropositive women b etween 1990 and 1993 in two hospitals in Washington, D.C. We identifie d 329 such symptom-free infants (syphilis group). The cerebrospinal fl uid (CSF) VDRL was reactive in two (0.6%) infants. The CSF leukocyte a nd protein concentrations of these infants were compared with those in 84 symptom-free control infants who were born to seronegative women a nd who had LPs performed in 1993 to rule out sepsis because of associa ted risk factors. Control infants had negative results for bacterial c ultures (CSF and blood) and bacterial antigen tests (CSF and urine). R esults: Thirty control subjects and 67 infants in the syphilis group h ad traumatic taps (CSF erythrocytes >500 x 10(6)/L), and hence were ex cluded from the analysis of cell count and proteins. Birth weights and gestational ages were similar in both groups. The CSF leukocyte and p rotein values were similar in the syphilis group and in control infant s: mean CSF leukocytes 7.7 x 10(6)/L (mean 7.7/mm(3), range 0 to 57/mm (3), SD 8.8) versus 6.9 x 10(6)/L (mean 6.9/mm(3), range 0 to 31/mm(3) , SD 7), p = 0.5, and mean protein concentration 981 mg/L (range 270 t o 2280 mg/L, SD 376) versus 936 mg/L (range 360 to 1750 mg/L, SD 368), p = 0.96, respectively. The combination of CSF leukocyte values >5 x 10(6)/L (>5/mm(3)) or protein values >400 mg/L (>40 mg/dl) was found i n 97.8% of the infants in the syphilis group, compared with 95.3% of t he control group.Conclusion: Because of the low yield of reactive CSF VDRL and the similar CSF leukocyte and protein values in the syphilis group and the control infants, the role of routine LP in the initial e valuation of symptom-free infants for congenital syphilis should be re considered.