the cumulative incidence of meningitis is highest in the 1 month of life and is higher in preterm neonates than term neonates . it is one of the major causes of morbidity and mortality in neonatal age group . evaluation of the cerebrospinal fluid ( csf ) white blood cell ( wbc ) count , and glucose and protein concentrations is used to assess the probability of the presence of central nervous system ( cns ) infection . although normal values are well - established for csf cell counts and protein and glucose contents in children and adults , this is not the case for neonates . there is very scanty information regarding the range of csf values in high - risk term and preterm neonates with noninfected csf obtained by nontraumatic puncture , with no red blood cells ( rbc / mm = 0 ) . when faced with the need to make therapeutic decisions on the interpretation of csf parameters , the clinicians often use the normal  cutoff values for csf parameters in preterm neonates are 25 wbc / mm , 24 mg glucose / dl , and 170 mg protein / dl . the purpose of this study was to evaluate the composition of noninfected csf obtained by nontraumatic lumbar puncture ( rbc = 0/mm ) in neonates ( age < 28 days ) , specifically distinguishing csf profiles of those term babies compared with those premature infants , and to compare csf values between nontraumatic and traumatic puncture up to 500 rbc / mm in term neonates with the preterm ones . ours is a retrospective study done by reviewing the csf chart of the newborn babies who underwent lumbar puncture between january 2012 and september 2012 . the csf samples obtained by lumbar puncture from 120 neonates were examined by routine procedures . the csf wbc count was performed in improved neubauer hemocytometer , the csf protein and glucose were measured by enzymatic method in semiautomated biochemical analyzer . ( 1 ) age up to 28 days , 2(a ) nontraumatic puncture ( rbc = 0/mm ) , or ii 2(b ) traumatic puncture up to 500 rbc / mm , and ( 3 ) accessible clinical data . informed consent was taken from each and every patient party before including the patients in our study . ( 1 ) nontraumatic hemorrhagic csf , ( 2 ) neonates having clinical evidence of infection ( clinical information was obtained retrospectively from chart review ) . ( 1 ) age up to 28 days , 2(a ) nontraumatic puncture ( rbc = 0/mm ) , or ii 2(b ) traumatic puncture up to 500 rbc / mm , and ( 3 ) accessible clinical data . informed consent was taken from each and every patient party before including the patients in our study . ( 1 ) nontraumatic hemorrhagic csf , ( 2 ) neonates having clinical evidence of infection ( clinical information was obtained retrospectively from chart review ) . among the 120 csf samples obtained by lumbar puncture , 25 ( term 10 , preterm 15 ) were excluded according to excluding criteria . therefore the cytological parameters , protein and glucose values were studied in 50 term babies and 45 preterm babies . ten csf samples from the term and five samples from the preterm neonates were found to be traumatic ( rbc < 500/mm ) . standard statistical methods ( student t - test ) were used in evaluation and p < 0.05 was considered as statistical significant difference . by comparing csf parameters between term gestation neonate group with premature neonate one , nontraumatic puncture , there was no statistically significant difference ( p < 0.05 ) in the mean wbc ( p = 0.6 ) . the mean protein concentration was significantly greater in those premature neonates ( p < 0.04 ) . the mean glucose concentration was also analogous in both groups ( p = 0.5 ) [ table 1 ] . cerebrospinal fluid parameters in term vs preterm neonates by comparing csf parameters in traumatic puncture with nontraumatic puncture performed on full - term gestation neonates , the mean glucose concentration was significantly lesser in the traumatic puncture group ( p < 0.02 ) [ table 2 ] . regarding premature neonates , the mean protein concentration was significantly greater in the traumatic puncture group ( p < 0.05 ) . the glucose concentration was also lesser in these children but the difference was not significant [ table 3 ] . cerebrospinal fluid parameters in term neonates ; nontraumatic vs traumatic cerebrospinal fluid parameters in preterm neonates ; nontraumatic vs traumatic the proper interpretation of csf results depends on knowledge of normal values in the group of patients being evaluated . several authors have pointed out that there is an acceptable variability in the csf profile , especially csf wbc count in neonates . furthermore , early detection of neonatal meningitis is a continuing concern in the neonatal intensive care unit . several studies showed that the average csf wbc count is 6 - 7 cell / mm in neonates , but these studies evaluated healthy neonates ; this is very close to the results we found ( 5.5/mm and 5.1/mm ) . however , greater number of cells may be normal ( 28 wbc / mm ) . luz , studying a full - term gestation and normal neonate group , found that the csf wbc count can be up to 12 wbc / mm and the protein concentration can be up to 120 mg / dl ; although this author studied csf samples with up to 600 rbc / mm , these values are close to ours [ tables 1 and 2 ] . the mean protein concentration was significantly greater in the premature group and this is probably due to the more immature blood - brain barrier in these children when compared with term babies ( p < 0.04 ) . this parameter in both groups was slightly lesser than those previously reported in the literature . when we compared traumatic puncture with nontraumatic puncture , we found that the mean glucose concentration was significantly lesser when the puncture was traumatic ( p < 0.02 ) in term neonates ; in premature neonates the mean glucose concentration was also lesser in the traumatic puncture group , but the difference was not significant ( p < 0.20 ) ; it is possible that some of the patients included in the group of traumatic puncture were in fact patients with cns hemorrhage what could explain the lower glucose concentrations ; the mean protein concentration was greater in children who underwent traumatic puncture in the premature neonate group ( p < 0.05 ) . these data show how traumatic puncture , even with rbc up to 500/mm , interferes on csf analysis and changes its parameters . the csf profile , like any other laboratory determination , should be evaluated within the clinical context of the individual case . the mean csf protein concentration is significantly greater in those premature neonates compared with those full - term gestation neonates . traumatic puncture , even up to 500 rbc / mm , interferes on csf parameters . but there are certain limitations in our study like small number of samples(n=95 ) , short duration , single centre study applied on healthy individuals . a prospective study using mortality and neurodevelopmental follow up will better define the utility of csf parameters in the premature neonate .
background : evaluation of the cerebrospinal fluid ( csf ) white blood cell ( wbc ) count and glucose and protein concentrations is used to assess the probability of the presence of central nervous system ( cns ) infection . 
 although normal values are well established for csf cell counts and protein and glucose contents in children and adults , this is not the case for neonates.aims:the purpose of this study was to evaluate the composition of noninfected csf obtained by nontraumatic lumbar puncture in neonates ( age<28 days ) , specifically distinguishing csf profiles of those term babies compared with those premature infants.materials and methods : the csf samples obtained by lumbar puncture from 120 neonates were examined by routine procedures.results:by comparing csf parameters between term gestation neonate group with premature neonate one , nontraumatic puncture , there was no statistically significant difference ( p<0.05 ) in the mean wbc ( p=0.6 ) . 
 the mean protein concentration was significantly greater in those premature neonates ( p<0.04 ) . 
 the mean glucose concentration was also analogous in both groups ( p=0.5).conclusion : the csf profile , like any other laboratory determination , should be evaluated within the clinical context of the individual case .