Abstract 62

Reference values for WBC count in the cerebrospinal fluid (CSF) of neonates are based on "high-risk" infants. Controversy exists regarding the normal values, and overlap between reference values and the CSF WBC count in neonates with meningitis can be found. Objectives: a) To examine the WBC count in the CSF of normal term neonates, and b) to compare the CSF WBC count of normal and "high-risk" infants. Methods: Neonates were included if (1) acute toxoplasma infection was documented during pregnancy, and the infant underwent a lumbar puncture as part of the evaluation of infants at risk for congenital toxoplasma infection, and (2) serial specific serum IgG and IgM determinations ruled-out congenital infection. CSF WBC count was determined in a counting chamber, and 6 bloody contaminated samples (>1000 RBC/mm3) were excluded. Results: 24 neonates in the first 8 days of life were studied: 16 were asymptomatic, and 8 were symptomatic "high-risk" infants (1 had gastroenteritis, 2 omphalitis, 3 transitory jitteriness, 2 suspicion for sepsis with sterile blood, CSF, and urine). No significant differences were found between the 2 groups regarding gestational age, birth weight, sex, 5 min Apgar score, and age of lumbar puncture. The mean ± SD CSF WBC count for asymptomatic neonates was 1.5 ± 1.7/mm3 (95% CI 0.6 to 2.4), with a median of 1.5/mm3 and a range of 0 to 5/mm3; in symptomatic neonates WBC count was 9.6 ± 10.1/mm3 (95% CI 1.2 - 18.1/mm3), with a median of 7/mm3, and a range 0 to 29/mm3. CSF WBC count was higher in symptomatic infants(p<0.05). Conclusion: CSF profile in healthy neonates might be similar to adults', containing up to 5 WBCs/mm3. The presence of more WBCs in the CSF of high risk neonates without central nervous system infection deserves further evaluation.