Honing in on neurodevelopmental effects of neonatal infection in very preterm infants

Abstract

A regional cohort of 110 infants born at ≤32 weeks gestational age and cared for at Christchurch Women's Hospital, New Zealand, were followed under protocol to 9 years of age to evaluate the long-term effects of neonatal infection. At term equivalency age, infants had structural imaging performed by magnetic resonance imaging (MRI). At 9 years of age, neuromotor function, IQ, educational achievement, and mental health were assessed.Long-term neurodevelopmental impairments were found in the group of infants with culture-confirmed bloodstream, central nervous system or urinary tract infection, or necrotizing enterocolitis of stage 2 or greater. Infants with suspected but unconfirmed “sepsis” did not have heightened risk of these adverse outcomes. The authors also found that cerebral white matter abnormalities apparent on term-equivalency MRI contributed to associations between confirmed infection and some neurodevelopmental outcomes. The careful definition of the exposure-of-interest, as well as imaging studies and 9-year evaluations using standardized testing, are substantial strengths of this study.Findings may favor what can be said to parents early on, and certainly should add a requirement for specificity in definition of subjects’ exposure to infection (ie, whether confirmed) in studies of outcomes.Article page 97▶ A regional cohort of 110 infants born at ≤32 weeks gestational age and cared for at Christchurch Women's Hospital, New Zealand, were followed under protocol to 9 years of age to evaluate the long-term effects of neonatal infection. At term equivalency age, infants had structural imaging performed by magnetic resonance imaging (MRI). At 9 years of age, neuromotor function, IQ, educational achievement, and mental health were assessed. Long-term neurodevelopmental impairments were found in the group of infants with culture-confirmed bloodstream, central nervous system or urinary tract infection, or necrotizing enterocolitis of stage 2 or greater. Infants with suspected but unconfirmed “sepsis” did not have heightened risk of these adverse outcomes. The authors also found that cerebral white matter abnormalities apparent on term-equivalency MRI contributed to associations between confirmed infection and some neurodevelopmental outcomes. The careful definition of the exposure-of-interest, as well as imaging studies and 9-year evaluations using standardized testing, are substantial strengths of this study. Findings may favor what can be said to parents early on, and certainly should add a requirement for specificity in definition of subjects’ exposure to infection (ie, whether confirmed) in studies of outcomes. Article page 97▶ Neonatal Infection and Later Neurodevelopmental Risk in the Very Preterm InfantThe Journal of PediatricsVol. 170PreviewTo document associations between confirmed and suspected neonatal infection and motor, cognitive, educational, and mental health outcomes of very preterm (VPT)-born children at 9 years of age; to examine the potential intervening role of cerebral white matter abnormalities (WMAs) and structural development on term magnetic resonance imaging. Full-Text PDF