Pro-inflammatory cerebrospinal fluid profile of neonates with intraventricular hemorrhage: clinical relevance and contrast with CNS infection

Background Interpretation of cerebrospinal fluid (CSF) studies can be challenging in preterm infants. We hypothesized that intraventricular hemorrhage (IVH), post-hemorrhagic hydrocephalus (PHH), and infection (meningitis) promote pro-inflammatory CSF conditions reflected in CSF parameters. Methods Biochemical and cytological profiles of lumbar CSF and peripheral blood samples were analyzed for 81 control, 29 IVH grade 1/2 (IVH 1/2 ), 13 IVH grade 3/4 (IVH 3/4 ), 15 PHH, 20 culture-confirmed bacterial meningitis (BM), and 27 viral meningitis (VM) infants at 36.5 ± 4 weeks estimated gestational age. Results PHH infants had higher ( p < 0.02) CSF total cell and red blood cell (RBC) counts compared to control, IVH 1/2 , BM, and VM infants. No differences in white blood cell (WBC) count were found between IVH 3/4 , PHH, BM, and VM infants. CSF neutrophil counts increased ( p ≤ 0.03) for all groups compared to controls except IVH 1/2 . CSF protein levels were higher ( p ≤ 0.02) and CSF glucose levels were lower ( p ≤ 0.003) for PHH infants compared to all other groups. In peripheral blood, PHH infants had higher ( p ≤ 0.001) WBC counts and lower ( p ≤ 0.03) hemoglobin and hematocrit than all groups except for IVH 3/4 . Conclusions Similarities in CSF parameters may reflect common pathological processes in the inflammatory response and show the complexity associated with interpreting CSF profiles, especially in PHH and meningitis/ventriculitis.