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Neonatal Infection and Later Neurodevelopmental Risk in the Very Preterm Infant

Katherine M Rand1, Nicola C Austin2, Terrie E Inder3

  • 1Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA.

The Journal of Pediatrics
|December 29, 2015
PubMed

Insights

Neonatal infections in very preterm infants increase risks for motor, cognitive, and mental health issues later in childhood. White matter abnormalities partially explain these links, but ADHD mechanisms require further study.

Area of Science:

  • Neonatal Medicine
  • Neurodevelopmental Pediatrics
  • Pediatric Neurology

Background:

  • Neonatal infections are a concern for very preterm (VPT) infants.
  • Neurodevelopmental outcomes in VPT survivors are often affected by early-life events.
  • The role of brain structure, specifically white matter abnormalities (WMAs), in mediating these outcomes is not fully understood.

Purpose of the Study:

  • To investigate the association between neonatal infection (confirmed and suspected) and neurodevelopmental outcomes at 9 years in VPT children.
  • To explore the mediating role of cerebral WMAs and structural development in these associations.
  • To assess motor, cognitive, educational, and mental health outcomes.

Main Methods:

  • A cohort of 110 VPT infants born in Christchurch, New Zealand, was followed from birth to 9 years.
  • Infection was defined by positive cultures or clinical criteria (necrotizing enterocolitis, antibiotic use).
  • Structural MRI was performed at term-equivalent age; neurodevelopmental assessments (neuromotor, IQ, educational, mental health) were conducted at age 9.

Main Results:

  • 25% of VPT infants had confirmed and 23% had suspected neonatal infection.
  • Confirmed infection was linked to increased risks of severe motor impairment (OR 3.3), attention deficit hyperactivity disorder (ADHD) (OR 3.6), and IQ delay (OR 2.0) at age 9.
  • Cerebral WMAs mediated the association between confirmed infection and motor/IQ impairments, but not ADHD.

Conclusions:

  • Confirmed neonatal infection significantly increases the risk of neurodevelopmental impairments in VPT infants.
  • White matter abnormalities are a key factor linking infection to motor and cognitive deficits.
  • Further research is needed to elucidate the neurological mechanisms underlying ADHD in infected VPT infants.
Abstract

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