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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection
Barbara J Stoll1, Nellie I Hansen, Ira Adams-Chapman
1Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga 30322, USA.
Insights
Neonatal infections in extremely low-birth-weight (ELBW) infants are linked to worse neurodevelopmental and growth outcomes in early childhood. This study highlights the significant risks associated with infections in these vulnerable infants.
Area of Science:
- Neonatal intensive care
- Pediatric neurology
- Infectious diseases
Background:
- Neonatal infections are common in extremely low-birth-weight (ELBW) infants requiring intensive care.
- These infections pose significant risks for long-term health and development.
Purpose of the Study:
- To investigate the association between neonatal infections in ELBW infants and adverse neurodevelopmental and growth outcomes.
- To quantify the risks of specific infection types on early childhood development.
Main Methods:
- A prospective registry of 6093 infants (401-1000g birth weight) born between 1993-2001.
- Infants were classified into infection groups (uninfected, clinical infection, sepsis, sepsis with NEC, meningitis).
- Neurodevelopmental (cognitive, neuromotor, neurologic, vision, hearing) and growth outcomes assessed at 18-22 months corrected age.
Main Results:
- 65% of ELBW survivors experienced at least one neonatal infection.
- Infected infants had significantly higher odds of cerebral palsy (ORs 1.4-1.7), low developmental scores (ORs 1.3-2.4), and vision impairment (ORs 1.3-2.2).
- Neonatal infection was also linked to impaired head growth, a predictor of poor neurodevelopment.
Conclusions:
- Neonatal infections in ELBW infants are associated with poor neurodevelopmental and growth outcomes.
- Further research is needed to understand brain injury mechanisms and develop interventions.
Context:
Neonatal infections are frequent complications of extremely low-birth-weight (ELBW) infants receiving intensive care.
Objective:
To determine if neonatal infections in ELBW infants are associated with increased risks of adverse neurodevelopmental and growth sequelae in early childhood.
Design, Setting, And Participants:
Infants weighing 401 to 1000 g at birth (born in 1993-2001) were enrolled in a prospectively collected very low-birth-weight registry at academic medical centers participating in the National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth outcomes were assessed at a comprehensive follow-up visit at 18 to 22 months of corrected gestational age and compared by infection group. Eighty percent of survivors completed the follow-up visit and 6093 infants were studied. Registry data were used to classify infants by type of infection: uninfected (n = 2161), clinical infection alone (n = 1538), sepsis (n = 1922), sepsis and necrotizing enterocolitis (n = 279), or meningitis with or without sepsis (n = 193).
Main Outcome Measures:
Cognitive and neuromotor development, neurologic status, vision and hearing, and growth (weight, length, and head circumference) were assessed at follow-up.
Results:
The majority of ELBW survivors (65%) had at least 1 infection during their hospitalization after birth. Compared with uninfected infants, those in each of the 4 infection groups were significantly more likely to have adverse neurodevelopmental outcomes at follow-up, including cerebral palsy (range of significant odds ratios [ORs], 1.4-1.7), low Bayley Scales of Infant Development II scores on the mental development index (ORs, 1.3-1.6) and psychomotor development index (ORs, 1.5-2.4), and vision impairment (ORs, 1.3-2.2). Infection in the neonatal period was also associated with impaired head growth, a known predictor of poor neurodevelopmental outcome.
Conclusions:
This large cohort study suggests that neonatal infections among ELBW infants are associated with poor neurodevelopmental and growth outcomes in early childhood. Additional studies are needed to elucidate the pathogenesis of brain injury in infants with infection so that novel interventions to improve these outcomes can be explored.
