CEREBROSPINAL-FLUID VALUES IN THE TERM NEONATE

Background. Cerebrospinal fluid (CSF) values in the noninfected neonat e are not well delineated. Studies analyzing these values are inconsis tent in the criteria used to define the noninfected population. The pu rpose of our study was to examine CSF values in neonates in the first 30 days of life in whom infection was more thoroughly excluded than in previous reports. Stringent inclusion criteria defined the noninfecte d population, and the recently available polymerase chain reaction (PC R) for enteroviruses was used in addition to cultures to help exclude viral disease. Results were also stratified by age in weeks to evaluat e for any variability that occurs in CSF values during the first month of life. Methods. Neonates were selected from subjects enrolled in tw o studies on aseptic meningitis. Noninfected infants were identified b y the following criteria: (1) atraumatic lumbar puncture (less than or equal to 1000 red blood cells/mm(3)); (2) no antibiotic therapy befor e lumbar puncture; (3) sterile blood, CSF and urine bacterial cultures ; (4) neg ative CSF viral culture; and (5) negative CSF PCR for entero viruses. Results. The mean +/- so total CSF white blood cell count for 108 noninfected neonates was 7.3 +/- 14/mm(3) (95% confidence interva l 6.6 to 8.0/mm(3)) with a median of 4/mm(3) and a range of 0 to 130/m m.(3) There were no significant differences in the mean CSF white bloo d cell counts among age categories. Conclusions. The application of st ringent inclusion criteria and the use of the PCR yielded a population of infants that better represents the noninfected neonate than earlie r reports. These values can be used for reference in evaluating the fe brile or ill neonate.