| Description |
- Background: In infants with neurological symptoms, ischemic stroke and bacterial meningitis are possible. To rule out meningitis, clinicians often perform a lumbar puncture. However, there is minimal research describing the cerebrospinal fluid (CSF) of infants with stroke. In particular, whether their CSF parameters differ from bacterial meningitis is unknown. The objective of this study was to characterize the CSF parameters of infants with stroke and compare them to those without stroke and/or bacterial meningitis.
Methods: We obtained information on infants admitted to >300 neonatal intensive care units and discharged from 1997-2020 using the Pediatrix Clinical Data Warehouse. Analysis focused on infants from whom a CSF sample was obtained in the first 14 postnatal days, aligned with neonatal stroke presentation. We identified infants with bacterial meningitis, defined as growth of non-contaminant pathogenic bacteria in CSF culture, and infants with stroke, per clinician diagnosis. We compared CSF values of infants with stroke, meningitis, and neither condition using quantile regression. CSF parameters include glucose, protein, and counts of white blood cells, red blood cells, lymphocytes, monocytes, and segmented neutrophils.
Results: 30,092 infants who met study criteria received a lumbar puncture in the first 14 days of life. 88 (0.29%) infants had a stroke diagnosis, and 179 (0.59%) had meningitis. No infants had both conditions. Compared to infants with stroke, infants with bacterial meningitis had a higher median protein concentration (132 vs. 93, p < 0.0001) and lower median glucose concentration (46 vs. 51, p 0.0002). Infants with stroke had a significantly higher median red blood cell count (392 vs. 124, p 0.03) and monocyte count (40 vs. 18, p 0.0072) than infants with bacterial meningitis. At the upper range of CSF parameters using quantile regression at the 75th percentile, infants with bacterial meningitis additionally had a significantly higher white blood cell count (228 vs. 39, p < 0.0001), segmented neutrophil count (82 vs. 52, p < 0.0001), and lymphocyte count (48.5 vs. 31, p 0.04) than infants with stroke.
Conclusions: Although stroke and bacterial meningitis may present similarly in infants, there are differences in their CSF parameters. This may allow for faster recognition and initiation of appropriate treatment before standard CSF culture would return.
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