The Journal of Pediatrics
Volume 158, Issue 1 , Pages 130-134 , January 2011

Normative Cerebrospinal Fluid Profiles in Febrile Infants

Portions of the data were presented at the Pediatric Academic Societies Annual Meeting, May 15, 2005, Washington, DC.

Received 2 July 2009 ,Revised 21 June 2010 ,Accepted 13 July 2010.

References 

  1. Baraff LJ. Management of fever without source in infants and children. Ann Emerg Med. 2000;36:602–614
  2. Roberts M. The spinal fluid in the newborn with especial reference to intracranial hemorrhage. JAMA. 1925;85:500–503
  3. Stewart D. The normal cerebrospinal fluid in children. Arch Dis Child. 1928;3:96–108
  4. Waitz R. Le liquide cephalorachidien du nouveau-ne. Rev Franc Pediatr. 1928;4:1–56
  5. Samson K. Die liquordiagnostik im kindesaltor. Ergeb Inn Med Kinderheilkd. 1931;41:553
  6. Otila E. Studies on the cerebrospinal fluid in premature infants. Acta Paediatr. 1948;35(Suppl):8–100
  7. Wyers H, Bakker J. De liquor cerebro-spinalis van normale, a terme geboren neonati. Maandschrift Kindergenceskunde. 1954;22:253–263
  8. Widell S. On the cerebrospinal fluid in normal children and in patients with acute abacterial meningo-encephalitis. Acta Paediatr. 1958;47(Suppl 115):1–102
  9. Naidoo BT. The cerebrospinal fluid in the healthy newborn infant. S Afr Med J. 1968;42:933–935
  10. Sarff LD, Platt LH, McCracken GH. Cerebrospinal fluid evaluation in neonates: comparison of high-risk infants with and without meningitis. J Pediatr. 1976;88:473–477
  11. Vaz FA, Livramento JA, Spina-Franca A. [Cerebrospinal fluid in the healthy preterm newborn infant]. Arq Neuropsiquiatr. 1977;35:183–188
  12. Pappu LD, Purohit DM, Levkoff AH, Kaplan B. CSF cytology in the neonate. Am J Dis Child. 1982;136:297–298
  13. Statz A, Felgenhauer K. Development of the blood-CSF barrier. Dev Med Child Neurol. 1983;25:152–161
  14. Fukunaga FH. Cerebrospinal fluid—a re-examination. Hawaii Med J. 1984;43:194
  15. Portnoy JM, Olson LC. Normal cerebrospinal fluid values in children: another look. Pediatrics. 1985;75:484–487
  16. Bonadio WA, Stanco L, Bruce R, Barry D, Smith D. Reference values of normal cerebrospinal fluid composition in infants ages 0 to 8 weeks. Pediatr Infect Dis J. 1992;11:589–591
  17. Ahmed A, Hickey SM, Ehrett S, Trujillo M, Brito F, Goto C, et al. Cerebrospinal fluid values in the term neonate. Pediatr Infect Dis J. 1996;15:298–303
  18. Nascimento-Carvalho CM, Moreno-Carvalho OA. Normal cerebrospinal fluid values in full-term gestation and premature neonates. Arq Neuropsiquiatr. 1998;56:375–380
  19. Kestenbaum LA, Ebberson J, Zorc JJ, Hodinka RL, Shah SS. Defining cerebrospinal fluid white blood cell count reference values in neonates and young infants. Pediatrics. 2010;125:257–264
  20. Wald ER. Aseptic meningitis and urinary infection. Pediatr Infect Dis J. 2004;23:480;author reply 481
  21. Syrogiannopoulos GA, Grivea IN, Anastassiou ED, Triga MG, Dimitracopoulos GO, Beratis NG. Sterile cerebrospinal fluid pleocytosis in young infants with urinary tract infection. Pediatr Infect Dis J. 2001;20:927–930
  22. Adler-Shohet FC, Cheung MM, Hill M, Lieberman JM. Aseptic meningitis in infants younger than six months of age hospitalized with urinary tract infections. Pediatr Infect Dis J. 2003;22:1039–1042
  23. Shah SS, Zorc JJ, Levine DA, Platt SL, Kuppermann N. Sterile cerebrospinal fluid pleocytosis in young infants with urinary tract infections. J Pediatr. 2008;153:290–292
  24. Yam AO, Andresen D, Kesson AM, Isaacs D. Incidence of sterile cerebrospinal fluid pleocytosis in infants with urinary tract infection. J Paediatr Child Health. 2009;45:364–367
  25. Finkelstein Y, Mosseri R, Garty BZ. Concomitant aseptic meningitis and bacterial urinary tract infection in young febrile infants. Pediatr Infect Dis J. 2001;20:630–632
  26. Baraff LJ, Oslund SA, Schriger DL, Stephen ML. Probability of bacterial infections in febrile infants less than three months of age: a meta-analysis. Pediatr Infect Dis J. 1992;11:257–264
  27. Byington CL, Enriquez FR, Hoff C, Tuohy R, Taggart EW, Hillyard DR, et al. Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections. Pediatrics. 2004;113:1662–1666
  28. Baxter AL, Fisher RG, Burke BL, Goldblatt SS, Isaacman DJ, Lawson ML. Local anesthetic and stylet styles: factors associated with resident lumbar puncture success. Pediatrics. 2006;117:876–881
  29. Novak RW. Lack of validity of standard corrections for white blood cell counts of blood-contaminated cerebrospinal fluid in infants. Am J Clin Pathol. 1984;82:95–97
  30. Rubenstein JS, Yogev R. What represents pleocytosis in blood-contaminated (“traumatic tap”) cerebrospinal fluid in children?. J Pediatr. 1985;107:249–251
  31. Mehl AL. Interpretation of traumatic lumbar puncture. A prospective experimental model. Clin Pediatr (Phila). 1986;25:523–526
  32. Bonadio WA, Smith DS, Goddard S, Burroughs J, Khaja G. Distinguishing cerebrospinal fluid abnormalities in children with bacterial meningitis and traumatic lumbar puncture. J Infect Dis. 1990;162:251–254
  33. Mazor SS, McNulty JE, Roosevelt GE. Interpretation of traumatic lumbar punctures: who can go home?. Pediatrics. 2003;111:525–528
  34. Mayefsky JH, Roghmann KJ. Determination of leukocytosis in traumatic spinal tap specimens. Am J Med. 1987;82:1175–1181
  35. Barnett V, Lewis T. Outliers in statistical data. Chichester, NY: Wiley; 1994;
  36. Iglewicz B, Hoaglin D. How to detect and handle outliers. American Society for Quality Control. Milwaukee; 1993.
  37. Smithson M. Confidence intervals. Quantitative applications in the social sciences series. Belmont, CA: SAGE Publications; 2003;
  38. Sheskin D. Handbook of parametric and nonparametric statistical procedures. Boca Raton, FL Chapman and Hall/CRC. 2007;
  39. Harvala H, Robertson I, Chieochansin T, McWilliam Leitch EC, Templeton K, Simmonds P. Specific association of human parechovirus type 3 with sepsis and fever in young infants, as identified by direct typing of cerebrospinal fluid samples. J Infect Dis. 2009;199:1753–1760
  40. Verboon-Maciolek MA, Krediet TG, Gerards LJ, de Vries LS, Groenendaal F, van Loon AM. Severe neonatal parechovirus infection and similarity with enterovirus infection. Pediatr Infect Dis J. 2008;27:241–245
  41. Hall CB, Long CE, Schnabel KC, Caserta MT, McIntyre KM, Costanzo MA, et al. Human herpesvirus-6 infection in children. A prospective study of complications and reactivation. N Engl J Med. 1994;331:432–438
  42. Bonsu BK, Harper MB. Corrections for leukocytes and percent of neutrophils do not match observations in blood-contaminated cerebrospinal fluid and have no value over uncorrected cells for diagnosis. Pediatr Infect Dis J. 2006;25:8–11
  43. Rowe PC. Laboratory Values. In:  DeAngelis C,  Feigin R,  Warshaw J editor. Principles and practice of pediatrics. Philadelphia: JB Lippincott Company; 1990;p. 1980
  44. Choukair M. Blood chemistries/body fluids. In:  Siberry G,  Iannone R editor. The Harriet Lane handbook. 15 ed. St Louis: Mosby; 2000;
  45. Osborne JP, Pizer B. Effect on the white cell count of contaminating cerebrospinal fluid with blood. Arch Dis Child. 1981;56:400–401
  46. Feigin R. Bacterial meningitis beyond the newborn period. In:  DeAngelis C,  Feigin R,  Warshaw J editor. Principles and practice of pediatrics. Philadelphia: JB Lippincott Company; 1990;p. 1031

 Supported by the Robert Wood Johnson Generalist Physician Faculty Scholar Program (C.B.), National Institute of Child Health and Human Development (K24 HD047249-01A1 to C.B.), and Public Health Services research grant (UL1-RR025764) from the National Center for Research Resources. The authors declare no conflicts of interest.

PII: S0022-3476(10)00600-1

doi: 10.1016/j.jpeds.2010.07.022

The Journal of Pediatrics
Volume 158, Issue 1 , Pages 130-134 , January 2011

Article Tools

* Image Usage & Resolution