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Updated: Oct 29, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
The Effect of Neonatal Sepsis on Risk of Autism Diagnosis
Darios Getahun1,2, Michael J Fassett3,4, Anny H Xiang1
1Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Insights
Neonatal sepsis increases autism risk in children, regardless of birth timing (preterm or term). This association was observed across most racial/ethnic groups and both sexes, with a potentially stronger effect in girls.
Area of Science:
- Neonatal care
- Pediatric neurology
- Public health
Background:
- Neonatal sepsis is a serious infection in newborns.
- Autism Spectrum Disorder (ASD) is a neurodevelopmental condition with complex etiology.
- Understanding risk factors for ASD is crucial for early intervention.
Purpose of the Study:
- To investigate the association between neonatal sepsis and autism risk.
- To determine if this association varies by timing of sepsis exposure, child's sex, or race/ethnicity.
Main Methods:
- Retrospective cohort study utilizing electronic health records (EHR) from Kaiser Permanente Southern California.
- Included 469,789 mother-child dyads.
- Defined neonatal sepsis and autism diagnoses using clinical records and specialist diagnoses; adjusted for confounders.
Main Results:
- Children with neonatal sepsis had a higher incidence of autism diagnosis (3.43 vs. 1.73 per 1,000 person-years).
- Increased autism risk was associated with neonatal sepsis in both preterm and term infants.
- The association was significant across most racial/ethnic groups and sexes, except for Asian/Pacific Islanders, with a potentially stronger effect in girls.
Conclusions:
- Neonatal sepsis is a significant risk factor for autism diagnosis in both preterm and term-born children.
- The association between neonatal sepsis and autism is consistent across various demographic groups, with notable exceptions.
- Findings highlight the importance of considering neonatal infections in the context of neurodevelopmental outcomes.
Objective:
The study aimed to examine the association between neonatal sepsis and autism risk among children and whether the risk varied with the timing of exposure, child's sex, and race/ethnicity.
Study Design:
We conducted a retrospective cohort study using electronic health records (EHR) extracted from Kaiser Permanente Southern California Health Care System. Mother-child dyads were constructed by linking records of children born to member mothers and continuing to receive care through the system during the follow-up period with those of their biological mothers (n = 469,789). Clinical health records were used to define neonatal sepsis. Diagnosis of autism was made by medical specialists. Potential confounders included maternal sociodemographic factors, obstetrical history, child's age, sex, race/ethnicity, and maternal and child medical history. Incident rates and adjusted hazard ratios (aHR) were used to estimate the associations.
Results:
Compared with children without the diagnosis of autism, children with the condition were more likely to be from Asian/Pacific Islander descent and male sex. Exposed children showed higher rates of autism as compared with unexposed children (3.43 vs. 1.73 per 1,000 person-years, aHR: 1.67-95% confidence interval [CI]: 1.39-2.00). Both preterm (aHR: 1.47; 95% CI: 1.09-1.98) and term (aHR: 1.63; 95% CI: 1.29-2.06) births were associated with increased risk for autism. Although the magnitude of the HRs and incidence ratios for neonatal sepsis to increase autism risk varied between race ethnicities, neonatal sepsis was associated with significantly increased likelihood of autism diagnosis for all race-ethic groups except for Asian/Pacific Islanders. Although neonatal sepsis was associated with significantly increased autism risk for both boys and girls, incident rates and HR point estimates suggested that the effect may be stronger in girls.
Conclusion:
Neonatal sepsis is associated with increased risk of autism diagnosis in preterm- and term-born children. The association was significant for both girls and boys and all race ethnicities except for Asian-Pacific Islanders.
Key Points:
· Neonatal sepsis is associated with increased risk of autism diagnosis.. · The association was significant in preterm- and term-born children.. · The association was significant for all race/ethnicities except for Asian-Pacific Islanders..
