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Early Life Parechovirus Infection Neurodevelopmental Outcomes at 3 Years: A Cohort Study
Philip N Britton1, Karen Walker2, Brendan McMullan3
1Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia.
Insights
Human parechovirus (HPeV) infection in infancy did not cause developmental delays by age three. However, HPeV survivors experienced more behavioral issues than healthy children, impacting a small number clinically.
Area of Science:
- Pediatric Infectious Diseases
- Neurodevelopmental Pediatrics
- Child Psychology
Background:
- Human parechovirus (HPeV) is a significant cause of infant illness, sometimes presenting as sepsis-like symptoms.
- Long-term outcomes of HPeV infection, particularly neurodevelopmental and behavioral effects, require further investigation.
Purpose of the Study:
- To assess the long-term neurodevelopmental and behavioral outcomes in children hospitalized with HPeV infection and sepsis-like illness during infancy.
- To compare outcomes with a control group of healthy children.
Main Methods:
- A cohort of 50 children hospitalized with HPeV during an Australian outbreak was followed for 3 years.
- Neurodevelopment was assessed using the Bayley Scales of Infant and Toddler Development-III.
- Behavioral outcomes were evaluated using the Child Behavior Checklist.
Main Results:
- Children with a history of HPeV infection showed normal neurodevelopmental attainment at 3 years of age, comparable to healthy controls.
- The HPeV cohort exhibited higher average scores and a greater frequency of clinical range scores on the Child Behavior Checklist.
- No significant neurodevelopmental delay was observed, but behavioral problems were more prevalent.
Conclusions:
- Infant HPeV sepsis-like illness is not associated with neurodevelopmental delay at age three.
- HPeV infection is linked to an increased incidence of behavioral problems in early childhood.
- Findings support the need for targeted clinical management and planning for children recovering from severe HPeV infections.
Objective:
To investigate the long-term developmental and behavioral outcomes in an established cohort of children hospitalized as infants with human parechovirus (HPeV) infection and sepsis-like illness.
Study Design:
The HPeV cohort was composed of children 3 years of age after HPeV infection and hospitalization in early infancy that occurred during a well-documented HPeV genotype 3 outbreak in Australia. We assessed neurodevelopmental and behavioral outcomes using the Bayley Scales of Infant and Toddler Development-III and the Child Behavior Checklist. We compared their outcomes with a subsample of healthy control infants drawn from the independently sampled Triple B Pregnancy Cohort Study.
Results:
Fifty children, with a mean age of 41 months, were followed for 3 years after hospital admission with HPeV infection. There were 47 children whose original illness was fever without source or sepsis-like illness and 3 who had encephalitis. All children in the HPeV cohort showed age-specific development within the population normal range on the Bayley Scales of Infant and Toddler Development-III. There was no difference in developmental attainment compared with 107 healthy control infants after adjusting for measured confounders. The HPeV cohort showed higher average scores on the Child Behavior Checklist and a higher frequency of clinical range scores compared with healthy controls.
Conclusions:
Although HPeV sepsis-like illness did not result in neurodevelopmental delay at 3 years of age, it was associated with increased behavioral problems compared with healthy controls. The behavioral problems reached a clinical threshold in a minority of children. Results inform clinical management and planning for children after severe HPeV infection in infancy.
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