ASSOCIATION OF CEREBROSPINAL FLUID BIOCHEMICAL PARAMETERS WITH BLOOD AND CEREBROSPINAL FLUID CULTURE RESULTS IN NEONATAL MENINGITIS: A CROSS SECTIONAL STUDY

Abstract

Background: Neonatal meningitis remains a major cause of morbidity and mortality, particularly in resource limited settings where culture-based diagnosis is often limited. Cerebrospinal fluid (CSF) biochemical parameters may aid in early diagnosis, especially in culture negative cases. Objective: To evaluate the association of CSF biochemical parameters with blood and CSF culture results in neonates with suspected meningitis. Methodology: This cross-sectional study was conducted at Pediatric Department KTH Peshawar, from December 2025 to May 2026, including 141 neonates (0–28 days) with suspected meningitis. CSF protein, glucose, and WBC count were analyzed and categorized as normal or abnormal using standard cutoffs. Blood and CSF cultures were performed. Associations were assessed using Chi square/Fisher’s exact test, and diagnostic performance was evaluated using sensitivity, specificity, predictive values, and accuracy. Results: Abnormal CSF findings included elevated WBC (71.6%), protein (63.8%), and low glucose (56.0%). CSF and blood culture positivity were 12.1% and 18.4%, respectively. Significant associations were observed between CSF and blood culture positivity with elevated protein (p=0.018, 0.045), low glucose (p=0.021, 0.024), and elevated WBC (p=0.009, 0.031) respectively. Diagnostic performance showed high sensitivity for WBC (94.1%), protein (88.2%), and glucose (82.4%), with corresponding NPVs of 97.5%, 96.1%, and 95.2%, but low specificity. Conclusion: CSF biochemical parameters, particularly WBC count, are useful screening markers due to their high sensitivity and negative predictive value, but their low specificity and positive predictive value limit their role in confirming neonatal meningitis. Therefore, they should be interpreted alongside clinical and microbiological findings.