Cerebrospinal Fluid Reference Values for Young Infants Undergoing Lumbar Puncture

Thomson, Joanna; Sucharew, Heidi; Cruz, Andrea T.; Nigrovic, Lise E.; Freedman, Stephen B.; Garro, Aris; Balamuth, Fran; Mistry, Rakesh D.; Arms, Joseph; Ishimine, Paul; Kulik, Dina M.; Neuman, Mark I.; Shah, Samir S.

doi:10.1542/peds.2017-3405

Cited by 71 publications

(55 citation statements)

References 27 publications

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“…Using the relative marginal modeled estimates of LOS (tested vs not tested), we determined the percentage increase in LOS. We then repeated the analyses after stratifying by the location of testing (ie, in-house vs send-out), age (≤28 days vs 29-60 days), and presence or absence of CSF pleocytosis (defined as a CSF WBC of ≥16 cells/mm 3 for infants aged ≤28 days and ≥10 cells/mm 3 for infants aged 29-60 days), 7 because infants aged 29-60 days and those without CSF pleocytosis are reported to be at very low risk for CNS HSV infection. 3,8 We utilized Stata Data Analysis and Statistical Software, version 15.0 (StataCorp, Inc.; College Station, Texas) for statistical analyses.…”

Section: Discussionmentioning

confidence: 99%

Association of Herpes Simplex Virus Testing with Hospital Length of Stay for Infants ≤60 Days of Age Undergoing Evaluation for Meningitis

Aronson

Cruz

Freedman

et al. 2019

Journal of Hospital Medicine

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Although neonatal herpes simplex virus (HSV) causes significant morbidity, utilization of the cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) test remains variable. Our objective was to examine the association of CSF HSV PCR testing with length of stay (LOS) in a 20-center retrospective cohort of hospitalized infants aged ≤60 days undergoing evaluation for meningitis after adjustment for patient-level factors and clustering by center. Of 20,496 eligible infants, 7,399 (36.1%) had a CSF HSV PCR test performed, and 46 (0.6% of those tested) had a positive test. Infants who had a CSF HSV PCR test performed had a 23% longer hospital LOS (incident rate ratio 1.23; 95% CI: 1.14-1.33). Targeted CSF HSV PCR testing may mitigate the impact on LOS for low-risk infants.

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Section: Discussionmentioning

confidence: 99%

Association of Herpes Simplex Virus Testing with Hospital Length of Stay for Infants ≤60 Days of Age Undergoing Evaluation for Meningitis

Aronson

Cruz

Freedman

et al. 2019

Journal of Hospital Medicine

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“…We extracted data pertaining to the hospitalization from medical records, including patient demographics, clinical characteristics, intravenous antibiotic and/or antiviral use, microbiological testing, and other laboratory values (CSF cell count and biochemistry). CSF pleocytosis was defined according to patient age: > 15 cells/μL for subjects ≤ 28 days of age, > 9 cells/μL in subjects 29-60 days old, and > 6 cells/μL in subjects > 60 days old [9][10][11].…”

Section: Data Collectionmentioning

confidence: 99%

Impact of decreasing cerebrospinal fluid enterovirus PCR turnaround time on costs and management of children with suspected enterovirus meningitis

Alghounaim

Caya

Cho

et al. 2020

Eur J Clin Microbiol Infect Dis

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To estimate the impact of implementing in-hospital enterovirus (EV) polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) with same-day turn-around-time (TAT) on length-of-stay (LOS), antibiotic use and on cost per patient with suspected EV meningitis, compared with testing at an outside reference laboratory. A model-based analysis using a retrospective cohort of all hospitalized children with CSF EV PCR testing done between November 2013 and 2017. The primary outcome measured was the potential date of discharge if the EV PCR result had been available on the same day. Patients with positive EV PCR were considered for potential earlier discharge once clinically stable with no reason for hospitalization other than intravenous antibiotics. Descriptive statistics and cost-sensitivity analyses were performed. CSF EV PCR testing was done on 153 patients, of which 44 (29%) had a positive result. Median test TAT was 5.3 days (IQR 3.9-7.6). Median hospital LOS was 5 days (IQR 3-12). Most (86%) patients received intravenous antibiotics with mean duration of 5.72 ± 6.51 days. No patients with positive EV PCR had a serious bacterial infection. We found that same-day test TAT would reduce LOS and duration of intravenous antibiotics by 0.50 days (95%CI 0.33-0.68) and 0.67 days (95%CI 0.42-0.91), respectively. Same-day test TAT was associated with a cost reduction of 342.83CAD (95%CI 178.14-517.00) per patient with suspected EV meningitis. Compared with sending specimens to a reference laboratory, performing CSF EV PCR in-hospital with same-day TAT was associated with decreased LOS, antibiotic therapy, and cost per patient.

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“…Comparison of initial cerebrospinal fluid findings in infants with HSV and EV central nervous system infections by univariate analysis EV cases with CSF WBC > 2000 x106 /L had median CSF WBC of 2630 (range 2020-6400) x106 /L E CSF pleocytosis was defined as CSF white cell count >15 x10 6 /L for infants 0-28 days of age and >9x106 /L for infants beyond neonatal period6 Of neonates with spinal taps 22 (30%) neonates had…”

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confidence: 99%

Enteroviral and Herpes Simplex Virus Central Nervous System Infections in Infants <90 Days Old: A Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) Study

Petel

Barton

Renaud

et al. 2020

Preprint

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Background The relative contribution of viruses to central nervous system (CNS) infections in young infants is not clear. For viral CNS infections, there are limited data on features that suggest HSV etiology or on predictors of unfavorable outcome. Methods In this cross-sectional retrospective study, seven centers from the Pediatric Investigators Collaborative Network on Infections in Canada identified infants <90 days of age with CNS infection proven to be due to enterovirus (EV) or herpes simplex virus (HSV) January 1, 2013 through December 31, 2014. Results Of 174 CNS infections with a proven etiology, EV accounted for 103 (59%) and HSV for 7 (4%). All HSV cases and 41 (40%) EV cases presented before 21 days of age. Four HSV cases (57%) and 5 EV cases (5%) had seizures. Three (43%) HSV and 23 (23 %) EV cases lacked cerebrospinal fluid (CSF) pleocytosis. HSV cases were more likely to require ICU admission (p=0.010), present with seizures (p=0.031) and have extra-CNS disease (p<0.001). Poor long-term outcomes were more common in infants who had seizures. Conclusions Viruses accounted for approximately two-thirds of proven CNS infections in the first 90 days of life. Empiric therapy for HSV should be considered in suspected CNS infections in the first 21 days even in the absence of CSF pleocytosis unless CSF parameters are suggestive of bacterial meningitis.

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Cerebrospinal Fluid Reference Values for Young Infants Undergoing Lumbar Puncture

Abstract: The age-specific CSF WBC count, protein concentration, and glucose concentration reference values identified in this large, multicenter cohort of infants can be used to interpret the results of lumbar puncture in infants ≤60 days of age.

Cited by 71 publications

References 27 publications

Association of Herpes Simplex Virus Testing with Hospital Length of Stay for Infants ≤60 Days of Age Undergoing Evaluation for Meningitis

Association of Herpes Simplex Virus Testing with Hospital Length of Stay for Infants ≤60 Days of Age Undergoing Evaluation for Meningitis

Impact of decreasing cerebrospinal fluid enterovirus PCR turnaround time on costs and management of children with suspected enterovirus meningitis

Enteroviral and Herpes Simplex Virus Central Nervous System Infections in Infants <90 Days Old: A Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) Study

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Cerebrospinal Fluid Reference Values for Young Infants Undergoing Lumbar Puncture

Abstract: The age-specific CSF WBC count, protein concentration, and glucose concentration reference values identified in this large, multicenter cohort of infants can be used to interpret the results of lumbar puncture in infants ≤60 days of age.

Cited by 71 publications

References 27 publications

Association of Herpes Simplex Virus Testing with Hospital Length of Stay for Infants ≤60 Days of Age Undergoing Evaluation for Meningitis

Association of Herpes Simplex Virus Testing with Hospital Length of Stay for Infants ≤60 Days of Age Undergoing Evaluation for Meningitis

Impact of decreasing cerebrospinal fluid enterovirus PCR turnaround time on costs and management of children with suspected enterovirus meningitis

Enteroviral and Herpes Simplex Virus Central Nervous System Infections in Infants &lt;90 Days Old: A Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) Study

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Enteroviral and Herpes Simplex Virus Central Nervous System Infections in Infants <90 Days Old: A Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) Study