Composição do liquido cefalorrraqueano do recem-nascido normal: citometria, proteinorraquia e bilirrubinorraquia em 79 casos

Luz, Berta R.

doi:10.1590/S0004-282X1975000300002

Resumos

Estudo do LCR de recém-nascidos a termo e de parto normal, sem intercorrências perinatais, para verificar o quanto a xantocromia é devida à bilirrubinorraquia. Foi verificado que a bilirrubinorraquia é constante na primeira semana de vida e que sua concentração: não guarda relação com a concentração proteica total do LCR e/ou com os níveis de bilirrubina no soro; não sofre influência do número de hemácias e/ou de leucócitos presente na amostra. Os valores encontrados no LCR quanto ao número de leucócitos e de hemácias e às concentrações de proteínas totais e de bilirrubina são analisados na caracterização do LCR do recém-nascido normal na primeira semana de vida.

The study was made in order to verify if the bilirubin content of the cerebrospinal fluid (CSF) is constant during the first week of life, and their relations to: the concentrations of total proteins in the CSF and bilirubin in the blood serum; the red blood cells and leucocytes present in the CSF sample. The study was made in 79 normal newborns without perinatal problems or obstetrical abnormalities. The gestational ages were stablished through maternal anamnesis and the clinical evaluation of the newborn was made according to the patterns established by Usher & col., Lubchenko & col. and Lubchenko. All the pregnancies were over 37 weeks. The vital conditions of the newborn immediately after the delivery were calculated according to the patterns proposed by Apgar and Apgar & James. The first complete clinical examination was made in the first twelve hours of life. The cranial sizes were situated within the limits accepted as normal. The deliveries were head-first (only two were breech presentation). The cry was immediate after birth, the breathing well established in the first minute of life and the cut of the umbelical cord was made after the first respiratory movement. The deliveries were made in delivery rooms or surgical rooms always assisted by an obstetrician and a pediatrician. The collecting of venous blood to determine the serum concentration of bilirubin was made soon after lumbar punction for collecting CSF. Samples were collected in the second day of life in all the 79 newborns studied; in 40 of them, new samples were collected in the 7th day of life. CSF samples were analyzed as to: total white cells count; total red blood cells count; total protein concentration; bilirubin and haemoglobin concentrations according to the Kronholm & Lintrup nomogram. General data pertinent to weight, height and cranial size of the newborn children studied were the following: weight: 3.213.1 ± 286.9 g; height: 49.24 ± 1.12 cm; cranial size: 35.29 ± 0.89 cm. Most CSF supernadant were either xanthochromic or slightly xanthochromic. The following values were found for cells, proteins and pigments in the CSF: 1. Total white cell count at the second day of life: mean of 4.44 cells/cu.mm., standard deviation 3.83; in the seventh day the average of cells was 4.40 cu.mm. and standard deviation 3.33; no significant difference was found between these two values. 2. Red blood cell count in the second day of life: mean 155.76 red blood cells/cu.mm. with standard deviation of 223.48; in the seventh day the mean was 74.10 red blood cells/cu.mm. and standard deviation was 123.72. The average number of CSF red blood cells at the second day of life was found to be larger than the mean value at the seventh day. 3. Total protein concentration: the average of total protein (mgm/100 ml) was 71.44 with standard deviation of 24.15 in the second day of life; at the seventh day the average was 69.27 with standard deviation of 22.21. There were no significant statistical differences between these values. 4. No haemoglobin was found but bilirubin was always present. The average of bilirubin at the second day of life was 1.96 micromol/liter with standard deviation of 0.17; in the seventh day of life the average was 1.89 micromol/liter with standard deviation of 0.20. The difference between the second and seventh days of life, although statistically significant, is inconspicuous for clinical and diagnostic purposes. No significant correlation was found between the bilirubin concentration in the CSF, and the respective white cells, erythrocytes or protein concentration. No significant correlation was found between protein and bilirubin in normal newborn's CSF. No significant correlation was found between bilirubin concentration in the serum and that of the CSF.

Composição do liquido cefalorrraqueano do recem-nascido normal. Citometria, proteinorraquia e bilirrubinorraquia em 79 casos

Cerebrospinal fluid composition of normal newborn children: cytology, proteins, and bilirubin

Berta R. Luz

Centro de Investigações em Neurologia da Clínica Neurológica da mesma Faculdade: Médica responsável pelo Berçário da Maternidade da Santa Casa de São Paulo

RESUMO

Estudo do LCR de recém-nascidos a termo e de parto normal, sem intercorrências perinatais, para verificar o quanto a xantocromia é devida à bilirrubinorraquia. Foi verificado que a bilirrubinorraquia é constante na primeira semana de vida e que sua concentração: não guarda relação com a concentração proteica total do LCR e/ou com os níveis de bilirrubina no soro; não sofre influência do número de hemácias e/ou de leucócitos presente na amostra. Os valores encontrados no LCR quanto ao número de leucócitos e de hemácias e às concentrações de proteínas totais e de bilirrubina são analisados na caracterização do LCR do recém-nascido normal na primeira semana de vida.

SUMMARY

The study was made in order to verify if the bilirubin content of the cerebrospinal fluid (CSF) is constant during the first week of life, and their relations to: the concentrations of total proteins in the CSF and bilirubin in the blood serum; the red blood cells and leucocytes present in the CSF sample. The study was made in 79 normal newborns without perinatal problems or obstetrical abnormalities.

The gestational ages were stablished through maternal anamnesis and the clinical evaluation of the newborn was made according to the patterns established by Usher & col., Lubchenko & col. and Lubchenko. All the pregnancies were over 37 weeks. The vital conditions of the newborn immediately after the delivery were calculated according to the patterns proposed by Apgar and Apgar & James. The first complete clinical examination was made in the first twelve hours of life. The cranial sizes were situated within the limits accepted as normal. The deliveries were head-first (only two were breech presentation). The cry was immediate after birth, the breathing well established in the first minute of life and the cut of the umbelical cord was made after the first respiratory movement. The deliveries were made in delivery rooms or surgical rooms always assisted by an obstetrician and a pediatrician.

The collecting of venous blood to determine the serum concentration of bilirubin was made soon after lumbar punction for collecting CSF.

Samples were collected in the second day of life in all the 79 newborns studied; in 40 of them, new samples were collected in the 7th day of life. CSF samples were analyzed as to: total white cells count; total red blood cells count; total protein concentration; bilirubin and haemoglobin concentrations according to the Kronholm & Lintrup nomogram.

General data pertinent to weight, height and cranial size of the newborn children studied were the following: weight: 3.213.1 ± 286.9 g; height: 49.24 ± 1.12 cm; cranial size: 35.29 ± 0.89 cm.

Most CSF supernadant were either xanthochromic or slightly xanthochromic.

The following values were found for cells, proteins and pigments in the CSF:

1. Total white cell count at the second day of life: mean of 4.44 cells/cu.mm., standard deviation 3.83; in the seventh day the average of cells was 4.40 cu.mm. and standard deviation 3.33; no significant difference was found between these two values.

2. Red blood cell count in the second day of life: mean 155.76 red blood cells/cu.mm. with standard deviation of 223.48; in the seventh day the mean was 74.10 red blood cells/cu.mm. and standard deviation was 123.72. The average number of CSF red blood cells at the second day of life was found to be larger than the mean value at the seventh day.

3. Total protein concentration: the average of total protein (mgm/100 ml) was 71.44 with standard deviation of 24.15 in the second day of life; at the seventh day the average was 69.27 with standard deviation of 22.21. There were no significant statistical differences between these values.

4. No haemoglobin was found but bilirubin was always present. The average of bilirubin at the second day of life was 1.96 micromol/liter with standard deviation of 0.17; in the seventh day of life the average was 1.89 micromol/liter with standard deviation of 0.20. The difference between the second and seventh days of life, although statistically significant, is inconspicuous for clinical and diagnostic purposes.

No significant correlation was found between the bilirubin concentration in the CSF, and the respective white cells, erythrocytes or protein concentration. No significant correlation was found between protein and bilirubin in normal newborn's CSF. No significant correlation was found between bilirubin concentration in the serum and that of the CSF.

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Centro de Investigações em Neurologia Fac. de Medicina, Univ. de São Paulo Caixa Postal 5199 01000 São Paulo, SP Brasil.

Resumo de Tese de doutoramento apresentada à Faculdade de Medicina da Universidade de São Paulo, na Divisão de Pediatria do Departamento de Clínica Médica, dezembro 1972.

1. AMATUZIO, D. J.; WEBER, L. J. & NESBITT, S. Bilirubin and protein in the cerebrospinal fluid of jaundiced patients with severe liver disease with and without hepatic coma. J. Lab. clin. Med. 41:615, 1953.
2. APGAR, V. A proposal for a new method of evaluation of the newborn infant. Curr. Res. Anesth. 32:260, 1953.
3. APGAR, V. The newborn (Apgar) scoring system: reflection and advice. Pediat. Clin. N. Amer. 13:645, 1966.
4. APGAR, V. & JAMES, L. S. Further observations on the newborn scoring system. Amer. J. Dis. Child. 104:419, 1962.
5. BAPTISTA DOS REIS, J.; DINIZ, H. B. & WOISKI, J. R. Conceito de normalidade do líquido céfalo-raquiano no primeiro ano de vida. Hospital (Rio de Janeiro) 78:1457, 1970.
6. DIAMENT, A. J. O líquido cefalorraqueano no recém-nascido. Pediat. prát. (São Paulo) 35:189, 1964.
7. DIAMENT, A. J. Sistematização do exame neurológico de crianças normais no primeiro ano de vida. Rev. bras. Def. Mental 4:5, 1969.
8. DINIZ, H. B. Determinação da idade da criança em que o líquido cefalorraqueano atinge o padrão de normalidade do adulto. Matern. e Inf. (São Paulo) 16:291, 1957.
9. KRONHOLM, V. & LINTRUP, J. Spectrophotometry investigations of the cerebrospinal fluid in the near ultraviolet region. Acta psychiat. scand. 35:314, 1980.
10. LUBCHENCO, L. O. Assessment of gestacional age and development at birth. Pediat. Clin. N. Amer. 17:125, 1970.
11. LUBCHENCO, L. O.; HANSMAN, C.; DRESSLER, M. & BOYD, E. Intrauterine growth as estimated from liveborn birthweight data at 24 to 42 weeks of gestation. Pediatrics 32:793, 1963.
12. MALLOY, H. T. & EVELYN, K. A. The determination of bilirubin with the photoeletric colorimenter. J. biol. Chem. 119:481, 1937.
13. MARLET, J. M. Contribuição ao estudo da xantocromia do líquido cefalorraquidiano. Tese, Faculdade de Medicina de São Paulo (multilitado), 1971.
14. NAIDOO, B. T. The cerebrospinal fluid in the healthy newborn infant. S. Afr. med. J. 42:933, 1968.
15. SPINA-FRANÇA, A & AMAR, I. Proteinorraquia total. Variações relacionadas ao sexo e à idade. Arq. Neuro-Psiquiat. (São Paulo) 21:13, 1963.
16. STEMPFEL, R. & ZETTERSTRÖM, R. Cerebrospinal fluid bilirubin in the neonatal period with special reference to the development of kernicterus. Acta. paed. (Uppsala) 43:587, 1954.
17. STEMPFEL, R. & ZETTERSTROM, R. Concentration of bilirrubin on cerebrospinal fluid in hemolytic disease of the newborn. Pediatrics 16:184, 1955.
18. USHER, R.; MC LEAN, F. & SCOTT, K. E. Judgment of fetal age: clinical significance of gestational age and an objetive method for its assessment. Pediat. Clin. N. Amer. 13:835, 1966.
19. WIDELL, S. On the cerebrospinal fluid in normal children and in patients with acute abacterial meningo-encephalitis. Acta paediat. (Upsala) 47 (suppl. 115):1, 1958.
20. WOISKI, J. R.; BAPTISTA DOS REIS, J. & BARROS, H. E. V. Líquido cefalorraqueano do recém-nascido: conceito de normalidade. Arq. Neuro-Psiquiat. (São Paulo) 7:264, 1949.
21. WOLF, H. & HOEPFFNER, L. The cerebrospinal fluid in the newborn and premature infant. Wld. Neurol. 2:871, 1961.

Datas de Publicação

Publicação nesta coleção
05 Abr 2013
Data do Fascículo
Set 1975

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AMATUZIO, D. J.; WEBER, L. J. & NESBITT, S. Bilirubin and protein in the cerebrospinal fluid of jaundiced patients with severe liver disease with and without hepatic coma. J. Lab. clin. Med. 41:615, 1953.

[2] 2. APGAR, V. A proposal for a new method of evaluation of the newborn infant. Curr. Res. Anesth. 32:260, 1953.

[3] 3. APGAR, V. The newborn (Apgar) scoring system: reflection and advice. Pediat. Clin. N. Amer. 13:645, 1966.

[4] 4. APGAR, V. & JAMES, L. S. Further observations on the newborn scoring system. Amer. J. Dis. Child. 104:419, 1962.

[5] 5. BAPTISTA DOS REIS, J.; DINIZ, H. B. & WOISKI, J. R. Conceito de normalidade do líquido céfalo-raquiano no primeiro ano de vida. Hospital (Rio de Janeiro) 78:1457, 1970.

[6] 6. DIAMENT, A. J. O líquido cefalorraqueano no recém-nascido. Pediat. prát. (São Paulo) 35:189, 1964.

[7] 7. DIAMENT, A. J. Sistematização do exame neurológico de crianças normais no primeiro ano de vida. Rev. bras. Def. Mental 4:5, 1969.

[8] 8. DINIZ, H. B. Determinação da idade da criança em que o líquido cefalorraqueano atinge o padrão de normalidade do adulto. Matern. e Inf. (São Paulo) 16:291, 1957.

[9] 9. KRONHOLM, V. & LINTRUP, J. Spectrophotometry investigations of the cerebrospinal fluid in the near ultraviolet region. Acta psychiat. scand. 35:314, 1980.

[10] 10. LUBCHENCO, L. O. Assessment of gestacional age and development at birth. Pediat. Clin. N. Amer. 17:125, 1970.

[11] 11. LUBCHENCO, L. O.; HANSMAN, C.; DRESSLER, M. & BOYD, E. Intrauterine growth as estimated from liveborn birthweight data at 24 to 42 weeks of gestation. Pediatrics 32:793, 1963.

[12] 12. MALLOY, H. T. & EVELYN, K. A. The determination of bilirubin with the photoeletric colorimenter. J. biol. Chem. 119:481, 1937.

[13] 13. MARLET, J. M. Contribuição ao estudo da xantocromia do líquido cefalorraquidiano. Tese, Faculdade de Medicina de São Paulo (multilitado), 1971.

[14] 14. NAIDOO, B. T. The cerebrospinal fluid in the healthy newborn infant. S. Afr. med. J. 42:933, 1968.

[15] 15. SPINA-FRANÇA, A & AMAR, I. Proteinorraquia total. Variações relacionadas ao sexo e à idade. Arq. Neuro-Psiquiat. (São Paulo) 21:13, 1963.

[16] 16. STEMPFEL, R. & ZETTERSTRÖM, R. Cerebrospinal fluid bilirubin in the neonatal period with special reference to the development of kernicterus. Acta. paed. (Uppsala) 43:587, 1954.

[17] 17. STEMPFEL, R. & ZETTERSTROM, R. Concentration of bilirrubin on cerebrospinal fluid in hemolytic disease of the newborn. Pediatrics 16:184, 1955.

[18] 18. USHER, R.; MC LEAN, F. & SCOTT, K. E. Judgment of fetal age: clinical significance of gestational age and an objetive method for its assessment. Pediat. Clin. N. Amer. 13:835, 1966.

[19] 19. WIDELL, S. On the cerebrospinal fluid in normal children and in patients with acute abacterial meningo-encephalitis. Acta paediat. (Upsala) 47 (suppl. 115):1, 1958.

[20] 20. WOISKI, J. R.; BAPTISTA DOS REIS, J. & BARROS, H. E. V. Líquido cefalorraqueano do recém-nascido: conceito de normalidade. Arq. Neuro-Psiquiat. (São Paulo) 7:264, 1949.

[21] 21. WOLF, H. & HOEPFFNER, L. The cerebrospinal fluid in the newborn and premature infant. Wld. Neurol. 2:871, 1961.