Katherine M Rand1, Nicola C Austin2, Terrie E Inder3, Samudragupta Bora3, Lianne J Woodward4. 1. Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA. 2. Christchurch Women's Hospital, Christchurch, New Zealand; University of Otago, Dunedin, New Zealand. 3. Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. 4. Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: ljwoodward@bwh.harvard.edu.
Abstract
OBJECTIVES: To 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. STUDY DESIGN: A regional cohort of 110 infants born VPT in Christchurch, New Zealand were studied from birth to age of 9 years. Confirmed infection was defined as positive blood, cerebrospinal fluid or urine culture, and/or necrotizing enterocolitis ≥ stage 2. Suspected infection was defined as ≥ 5 days of antibiotics with evidence of clinical correlates. At term gestational equivalence, infants underwent structural magnetic resonance imaging. At age 9 years, neuromotor function, IQ, educational achievement, and mental health were assessed. RESULTS: During hospitalization, 25% of VPT infants had confirmed and 23% had suspected infection. Longer-term neurodevelopmental impairments were largely confined to infants with confirmed infection (relative risk 1.4-3.1, vs uninfected). After accounting for other neonatal factors, these infants were at increased risk of severe motor impairment (OR 3.3, 95% CI 1.3-8), attention deficit hyperactivity disorder (ADHD) (OR 3.6, 95% CI 1.6-8), and IQ delay (OR 2.0, 95% CI 1-3.9). Cerebral WMAs contributed to associations between confirmed infection and motor and IQ impairments but not to ADHD (P = .005). CONCLUSIONS: Confirmed neonatal infection heightens VPT infants' risk for neurodevelopmental impairment. WMA appears to be an important intervening factor linking infection and severe motor and IQ impairments. Further analysis of the neurologic mechanism accounting for ADHD in infants with infection is needed.
OBJECTIVES: To 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. STUDY DESIGN: A regional cohort of 110 infants born VPT in Christchurch, New Zealand were studied from birth to age of 9 years. Confirmed infection was defined as positive blood, cerebrospinal fluid or urine culture, and/or necrotizing enterocolitis ≥ stage 2. Suspected infection was defined as ≥ 5 days of antibiotics with evidence of clinical correlates. At term gestational equivalence, infants underwent structural magnetic resonance imaging. At age 9 years, neuromotor function, IQ, educational achievement, and mental health were assessed. RESULTS: During hospitalization, 25% of VPT infants had confirmed and 23% had suspected infection. Longer-term neurodevelopmental impairments were largely confined to infants with confirmed infection (relative risk 1.4-3.1, vs uninfected). After accounting for other neonatal factors, these infants were at increased risk of severe motor impairment (OR 3.3, 95% CI 1.3-8), attention deficit hyperactivity disorder (ADHD) (OR 3.6, 95% CI 1.6-8), and IQ delay (OR 2.0, 95% CI 1-3.9). Cerebral WMAs contributed to associations between confirmed infection and motor and IQ impairments but not to ADHD (P = .005). CONCLUSIONS: Confirmed neonatal infection heightens VPT infants' risk for neurodevelopmental impairment. WMA appears to be an important intervening factor linking infection and severe motor and IQ impairments. Further analysis of the neurologic mechanism accounting for ADHD in infants with infection is needed.
Authors: Elizabeth N Allred; Olaf Dammann; Raina N Fichorova; Stephen R Hooper; Scott J Hunter; Robert M Joseph; Karl Kuban; Alan Leviton; Thomas Michael O'Shea; Megan N Scott Journal: J Neuroimmune Pharmacol Date: 2017-04-12 Impact factor: 4.147
Authors: Elizabeth T Jensen; Jelske W van der Burg; Thomas M O'Shea; Robert M Joseph; Elizabeth N Allred; Tim Heeren; Alan Leviton; Karl C K Kuban Journal: J Pediatr Date: 2017-03-21 Impact factor: 4.406
Authors: H Reeve Bright; Kikelomo Babata; Elizabeth N Allred; Carmina Erdei; Karl C K Kuban; Robert M Joseph; T Michael O'Shea; Alan Leviton; Olaf Dammann Journal: J Pediatr Date: 2017-05-16 Impact factor: 4.406
Authors: Rachel E Lean; Rachel A Paul; Christopher D Smyser; Cynthia E Rogers Journal: J Child Psychol Psychiatry Date: 2017-09-19 Impact factor: 8.982
Authors: Kikelomo Babata; H Reeve Bright; Elizabeth N Allred; Carmina Erdei; Karl C K Kuban; Robert M Joseph; T Michael O'Shea; Olaf Dammann; Alan Leviton Journal: Early Hum Dev Date: 2018-04-24 Impact factor: 2.079
Authors: Sudhir Sriram; Michael D Schreiber; Michael E Msall; Karl C K Kuban; Robert M Joseph; T Michael O' Shea; Elizabeth N Allred; Alan Leviton Journal: Pediatrics Date: 2018-05-17 Impact factor: 7.124
Authors: Daniel S Tawfik; Jochen Profit; Eileen T Lake; Jessica B Liu; Lee M Sanders; Ciaran S Phibbs Journal: Health Serv Res Date: 2019-12-23 Impact factor: 3.402
Authors: Dana DeMaster; Johanna Bick; Ursula Johnson; Janelle J Montroy; Susan Landry; Andrea F Duncan Journal: Pediatr Res Date: 2018-10-16 Impact factor: 3.756
Authors: Amanda C Kentner; Staci D Bilbo; Alan S Brown; Elaine Y Hsiao; A Kimberley McAllister; Urs Meyer; Brad D Pearce; Mikhail V Pletnikov; Robert H Yolken; Melissa D Bauman Journal: Neuropsychopharmacology Date: 2018-08-21 Impact factor: 7.853