3 week old febrile neonate
The LP shows a moderately elevated protein, with a CSF:Blood glucose of 0.38. The is a moderately raised WCC with a predominant neutrophilia. There is a small number of RBC and no bacteria seen on the gram stain.
This LP results is highly suggestive of a bacterial meningitis, despite no bacteria seen on gram stain. Up to 60% of gram stains can be negative in bacterial meningitis. Further history with regards to the mother’s antenatal history and care, as well as the birth history need to be sort. In this age group the most likely causes of bacterial meningitis are group B strep, Ecoli and Listeria Monocytogenes. Cefotaxime 50mg/kg and Benzylpenicillin 60mg/kg ivi should be given as soon as LP is complete or within 30 minutes of presentation
| Neutrophils | Lymphocytes | Protein | Glucose (CSF:Blood) | Gram Stain | Appearance | ||
| Normal Term Neonate | 0 | <20 | <0.4 | >0.6 or >2.0mmol/l | No Bacteria | Clear | |
| Normal Term >1 month | 0 | <5 | <1.0 | >0.6 or >2.5mmol/l | No Bacteria | Clear | |
| Bacterial | 100-10000 | <100 | >1.0 | <0.4 | 60% gram stains can be clear | Turbid | |
| Viral | <100 | 10-1000 | 0.4-1.0 | Usually normal | No Bacteria | Mildy turbid/clear | |
| TB/Fungal | <100 | 50-1000 | 1.0-5.0 | <0.4 | Specific Stains needed | Turbid/Clear |