A RETROSPECTIVE CHART REVIEW OF CEREBROSPINAL FLUID CHARACTERISTICS OF INFANTS WHO PRESENT TO THE EMERGENCY DEPARTMENT WITH FEVER: ESTABLISHING NORMAL VALUES

Bacterial and viral meningitis are public health concerns as they are contagious and highly fatal without treatment. Newborn infants are at high risk for bacterial and viral meningitis. The onset of the infection is rapid and without quick diagnosis and treatment, many infants will die. Diagnosis requires the positive identification of the causative agent through culture or the use of polymerase chain reaction (PCR) from specimens of cerebrospinal fluid (CSF). Because these tests can take hours or days to perform, it is important identify children who have a higher likelihood of serious bacterial or viral infection so that empiric therapy can be initiated while awaiting further results. Previous studies have indicated that CSF characteristics can be accurate early predictors of viral and bacterial meningitis. Although CSF characteristics have been established for infection, normal values for infants less than 60 days of age are still not clear. To improve characterization of CSF values for infants, this study set to answer three questions: Is there a temporal relationship for CSF WBC, glucose, and protein? What are the means and confidence intervals for the means for each of these variables? What is the range of normal values that a physician could expect to find in infants less than two months of age? This study involved three independent retrospective chart reviews over a 15-year period to identify infants less than two months of age who presented to The Children's Hospital of Pittsburgh emergency department with fever and had lumbar punctures performed but were not found to have bacterial or viral meningitis. For CSF WBC and protein, the data from the three cohorts were pooled and a single set of reference values was generated for infants less than two months of age. CSF glucose values were not pooled due to differences that existed between the cohorts and reference values were calculated for the cohorts individually. CSF white blood cell (WBC), glucose, and protein values were analyzed to answer our three study objectives. A temporal trend was found for CSF WBC and protein with values being highest during the first weeks of life. CSF glucose values did not change with time. These values will be potentially valuable reference tools in emergency departments for physicians who are faced with decisions regarding care and treatment of febrile infants