The specificity and sensitivity of CSF and blood glucose concentration in the diagnosis of neonatal meningitis

Abstract

In a prospective study of high-risk newborn infants, the specificity and sensitivity of CSF/blood glucose ratio were studied in 35 newborn infants with meningitis and 100 high-risk neonates without meningitis. High CSF/blood glucose ratios of 0.93 (0.17) (Mean (S.D.) ) for preterm infants and 0.96 (0.30) (Mean (S.D.) ) for term infants were observed. The CSF/blood glucose ratios of less than 0.6 for preterm meningitic and less than 0.5 for term meningitic infants had the highest specificity (100%). The corresponding sensitivity of these ratios in the diagnosis of meningitis was 74.3% and 71.4% respectively. Similarly, an absolute CSF glucose value of less than 1.3 mmol/l in infants with meningitis was highly specific. Nevertheless, complete clinical evaluation of the infant is important if bacterial meningitis is suspected and the decision to treat should not be based on CSF glucose findings alone.

Meta-analysis of Cerebrospinal Fluid Cell Count and Biochemistry to Diagnose Meningitis in Infants Aged < 90 Days

“…Although many studies on the role of CSF cytochemistry in neonates and young infants have been published, the thresholds used varied widely across the studies. As a result, the reported sensitivities and specificities also varied [25][26][27][28][29] . Hence, there is a need to assess the diagnostic accuracy of the CSF cytochemistry and identify the optimal thresholds from the available data.…”

“…As a result, the reported sensitivities and specificities also varied. [25][26][27][28][29] Hence, there is a need to assess the diagnostic accuracy of the CSF cytochemistry and identify the optimal thresholds from the available data. We performed an exhaustive literature search but could not identify any systematic review and meta-analysis addressing these vital issues.…”

Cerebrospinal Fluid Infections

“…To eliminate doubt, a simultaneous plasma glucose should be done with each lumbar puncture where glucose is of importance, and a cerebrospinal fluid value below 50% of that of plasma should be considered abnormal [53]. For term and preterm infants, the normal cerebrospinal-fluid-to-plasmaglucose ratio is 0.74 to 0.96, and a ratio below 0.60 should suggest meningitis [67,81,85].…”