Abstract
Objectives: To identify and compare the cerebrospinal fluid (CSF) parameters that predict the presence of neonatal bacterial meningitis using optimal cutoff values, and to derive and compare predictive profiles based on a combination of individual parameters for the same purpose.Study Design: The retrospective component of the Shanghai Neonate Meningitis Cohort included all term neonates who underwent lumbar puncture between 2000 and 2017. Those with severe neurological diseases, histories of ventricular drainage, or traumatic lumbar punctures were excluded. Reference ranges were determined for non-bacterial meningitis neonates based on the 5th, 25th, 50th, 75th, and 95th CSF parameter quantiles, and their relationships with age were calculated using generalized additive models that tested for linear relationships. The optimal cutoff value for each measured CSF parameter was calculated using receiver operating characteristic analysis and by deriving the Youden's index. Parameters with good diagnostic efficacies were combined to produce predictive profiles using logistic regression. The diagnostic efficacies of the single parameters and profiles were compared in neonates with confirmed bacterial meningitis.Results: White blood cells (WBCs) in CSF showed a higher diagnostic ability for neonatal bacterial meningitis than CSF protein, glucose, lactate dehydrogenase, or chloride. The sensitivity and specificity of the diagnostic cutoff value for WBCs (20 × 106/L) were 95.1 and 98.7%, respectively. Profiles based on CSF parameter combinations improved the specificities slightly to 99.0–99.7%. However, employing predictive profiles did not improve sensitivities, which remained at 95.1–96.0%.Conclusions: Profiles for predicting neonatal bacterial meningitis improve the sensitivity and specificity of diagnosis slightly, although not appreciably, compared to the single parameter of CSF WBC alone.
Highlights
Bacterial meningitis more commonly occurs in the first month of life than at any other time [1]
To identify and compare the cerebrospinal fluid (CSF) parameters that predict the presence of neonatal bacterial meningitis using optimal cutoff values, and to derive and compare predictive profiles based on a combination of individual parameters for the same purpose
Profiles based on CSF parameter combinations improved the specificities slightly to 99.0–99.7%
Summary
Bacterial meningitis more commonly occurs in the first month of life than at any other time [1]. Some studies proposed that combined these parameters to build a predictive profile may improve the efficacy of diagnosing bacterial meningitis in neonates [8,9,10]. It has been reported that the normal ranges for CSF parameters vary according to gestational age, chronological age, and birth weight [12, 15,16,17,18]. This raises questions as to whether these diagnostic criteria are applicable to neonates and if these parameters are suitable as diagnostic indicators for newborns. We compared the efficacies of these single parameters and derived profiles in terms of diagnosing bacterial meningitis neonates
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