Creatine kinase brain isoenzyme (CK-BB) was examined in the cerebrospinal fluid of 150 neonates at the Departments of Pediatrics and Neonatal Medicine and Clinical Chemistry, University Hospital, Ghent, Belgium. Indications for lumbar puncture were intraventricular hemorrhage, subarachnoid hemorrhage, postasphyxial encephalopathy, convulsions, birth trauma, periventricular echodensities, or question of sepsis. Newborns with a neurologic disorder showed significantly higher concentrations of immunoreactive CK-BB than did normal newborns or those with subarachnoid hemorrhage. (The median CK-BB for 5 neonates with intraventricular hemorrhage and echodensities was 106 mcg/l and the normal control was 2.14.) An independent effect of seizures on the CK-BB concentration was not documented. High concentrations of CSF CK-BB in the neonatal period were correlated with an adverse outcome - that is death or abnormal neurologic exam at discharge. [1]

COMMENT. Determination of the CK-BB concentration in CSF appears to be a clinically useful test for the prediction of neurologic disorders in high risk neonates. Infants with high CSF CK-BB concentrations should receive careful follow-up. In a previous study [2] an elevated serum CPK measured within 4 hours after birth was a sensitive indicator of brain damage in asphyxiated term infants but was of limited prognostic value in assessment of neurological outcome. [3]

Cerebro spinal fluid examination in symptom-free infants with risk factors for infection was evaluated in 284 newborns at the Department of Pediatrics, Rush Presbyterian-St. Luke’s Medical Center, Chicago, IL [4]. Positive cultures without pleocytosis in 5 infants (1.8%) were contaminants and none of the symptom-free infants had meningitis. The authors conclude that CSF examination is not indicated in the diagnostic evaluation of symptom-free infants born to mothers with chorioamnionitis or other risk factors for neonatal infection.