Diagnostic Utility of Cerebrospinal Fluid White Blood Cell Components for the Identification of Bacterial Meningitis in Infants.
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2023-12
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Abstract
Background
To evaluate the diagnostic and predictive utility of cerebrospinal fluid (CSF) white blood cell (WBC) components in the diagnosis of bacterial meningitis in infants discharged from the neonatal intensive care unit (NICU).Methods
We identified a cohort of infants discharged from a Pediatrix NICU between 1997 and 2020 who did not have an immunodeficiency, had at least 1 CSF culture collected within the first 120 days of life, and at least 1 CSF laboratory specimen obtained on the day of culture collection. We only included an infant's first CSF culture and excluded cultures from CSF reservoirs and those growing contaminants or nonbacterial organisms. We examined the utility of CSF WBC components to diagnose or predict bacterial meningitis by calculating sensitivity, specificity, positive and negative predictive values, likelihood ratios, and area under the receiver operating curve (AUC) at different cutoff values for each parameter. We performed subgroup analysis excluding infants treated with antibiotics the day before CSF culture collection.Results
Of the 20 756 infants that met the study inclusion criteria, 320 (2%) were diagnosed with bacterial meningitis. We found (AUC [95% CI]) CSF WBC count (0.76 [0.73-0.79]), CSF neutrophil count (0.74 [0.70-0.78]), and CSF neutrophil percent (0.71 [0.67-0.75]) had the highest predictive values for bacterial meningitis, even when excluding infants with early antibiotic administration.Conclusions
No single clinical prediction rule had the optimal discriminatory power for predicting culture-proven bacterial meningitis, and clinicians should be cautious when interpreting CSF WBC parameters in infants with suspected meningitis.Type
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Lamb, Ashley E, Sharla Rent, Asia J Brannon, Jonathan L Greer, Nyssa P Ndey-Bongo, Stephen H Cho, Rachel G Greenberg, Daniel K Benjamin, et al. (2023). Diagnostic Utility of Cerebrospinal Fluid White Blood Cell Components for the Identification of Bacterial Meningitis in Infants. Journal of the Pediatric Infectious Diseases Society, 12(Supplement_2). pp. S44–S52. 10.1093/jpids/piad087 Retrieved from https://hdl.handle.net/10161/35571.
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Sharla Marie Rent
Sharla Rent, MD, MSc-GH, is an Associate Professor of Pediatrics and Global Health, with a faculty associate role in the Trent Center for Bioethics, Humanities & History of Medicine. Her work sits at the intersection of neonatal-perinatal medicine, global health, ethics, and palliative care, with a particular focus on improving care for newborns and families in both high-resource and low-resource settings. Her research addresses perinatal bereavement, neonatal resuscitation, donor human milk implementation, maternal mental health, and the ethical dimensions of neonatal and perinatal care. She has developed sustained international collaborations in Ethiopia, Tanzania, and Rwanda, where her work spans implementation science, educational training, and qualitative research to strengthen health systems focused on maternal child health emergency care and to support families after perinatal loss. In parallel, she contributes to scholarship and leadership through roles in the American Academy of Pediatrics focused on global perinatal care.
Rachel Gottron Greenberg
Rachel G. Greenberg, MD, MB, MHS is a neonatologist and Professor of Pediatrics at Duke University Medical Center and Duke Clinical Research Institute. Dr. Greenberg’s research focuses on improving safety and efficacy of drugs in infants and children, particularly through her efforts as a Principal Investigator and Steering Committee Chair for the NICHD-funded Pediatric Trials Network. She is also alternate PI of the North Carolina clinical Center for the Neonatal Research Network and PI of the NICHD-funded HEAL KIDS Pain Resource and Data Center. In addition, she has been principal investigator of multiple trials funded by the U.S. Food and Drug Administration, Centers for Disease Control, and National Institutes of Health.
Daniel Kelly Benjamin
Dr. Danny Benjamin is the Principal Investigator and Chair of the National Institute of Child Health and Human Development’s Pediatric Trials Network. The Network is responsible for designing and leading clinical trials of off-patent medicines in children of all ages across all therapeutic areas. The team has established, or is actively studying, the correct dosing and safety of more than 100 of the most commonly used medicines in children. These trials are conducted under an Investigational New Drug (IND) application with guidance from the Food and Drug Administration for labeling.
The Pediatric Trials Network has directly impacted the healthcare of over 90% of American children.
Signature programs of the Network include clinical trials in premature, term infants, breast feeding mothers, and obese children. Over the past 10 years, Danny’s group has enrolled more premature infants, at more sites, in more clinical trials of off-patent anti-infectives under an IND than all other academic medical centers, pharmaceutical companies, and government agencies in the world, combined.
Danny is recognized by the National Institutes of Health as a premiere mentor and educator. His research program serves as a platform to train students and early career investigators. Danny’s group has a clinical research summer program for high school, college graduate school, and medical students that recruits and mentors ~30 students each academic year. He has been the primary or secondary mentor for 10 faculty who have received career development awards and who have then gone on to establish their own independent research programs; six of whom are now Distinguished Professors.
Danny's service to the community is expressed through his passion for coaching baseball. He has coached over 1,000 recreation league, travel league, and scholastic baseball games. He is the head coach for Smith Middle School Baseball, perennially southern conference champions. Danny and his wife own a charitable non-profit that provides athletic and fitness opportunities for disadvantaged and special-needs school-aged boys and girls.
Karan Ravindra Kumar
I am an Assistant Professor of Pediatrics and a Pediatric Critical Care Physician at Duke University School of Medicine, and I am also affiliated with the Duke Clinical Research Institute (DCRI). My research focuses on advancing pediatric healthcare through the integration of biostatistics, clinical research informatics, and data science. I have significant experience managing large datasets, including the Pediatrix Medical Group Clinical Data Warehouse and the NICHD-funded Pediatric Trials Network, which have provided vital insights into disease patterns and pediatric drug labeling. I contribute analytical support to various pediatric research initiatives. My efforts extend to exploring automation of data integration in clinical trials, enhancing research infrastructure, and leading critical trials and registries to improve pediatric health outcomes. I am enthusiastic about applying my expertise in biostatistics, database management, and predictive analytics to future projects.
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