There is considerable overlap between cerebrospinal fluid (CSF) parameters in neonates with and without bacterial meningitis. (Clin Pediatr [Phila]. 2020;59[9-10]:893; Pediatrics. 2018;141:e20173405; https://bit.ly/2CAc8oJ.)
Neonatal meningitis, for example, can occasionally occur with normal CSF parameters. What level of CSF WBC count should suggest meningitis and prompt admission for IV antibiotics when working up a febrile neonate? The most recent clinical practice guidelines based on recent literature on febrile infants aged 0 to 56 days show that evidence of meningitis on the lumbar puncture for infants younger than 28 days is >18 WBCs and for those older than 28 days is >9 WBCs. (Clin Pediatr [Phila]. 2020;59[9-10]:893.)
To be clear, this does not mean that CSF WBC counts below these thresholds exclude meningitis, but if performing an LP in a febrile infant aged 0 to 56 days to evaluate for meningitis, CSF WBC counts meeting these thresholds should be assumed to indicate meningitis until proven otherwise.
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