What is the role of CSF analysis in the workup of neonatal sepsis?

Updated: Jun 13, 2019
  • Author: Nathan S Gollehon, MD, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

CSF findings in infective neonatal meningitis are as follows:

  • Elevated white blood cell (WBC) count (predominantly polymorphonuclear neutrophils [PMNs])

  • Elevated protein level

  • Decreased glucose concentration

  • Positive culture results

  • Positive polymerase chain reaction (PCR)-based results

The CSF WBC count is within the reference range in 29% of group B Streptococcus (GBS) meningitis infections but in only 4% of gram-negative meningitis infections. Reference-range CSF protein and glucose concentrations are found in about 50% of patients with GBS meningitis but in only 15%-20% of patients with gram-negative meningitis. Obtaining a CSF culture is critical, in that neonatal meningitis is commonly present in neonates without bacteremia and with normal CSF findings. [53]

The decrease in CSF glucose concentration does not necessarily reflect serum hypoglycemia. Glucose concentration abnormalities are more severe in late-onset disease and with gram-negative infections.


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