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Updated: Sep 2, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal sepsis is associated with behavioral abnormalities in very low birthweight infants at preschool age
Vito Giordano1, Sophie Stummer1, Claudia Lindtner1
1Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria.
Insights
Neonatal sepsis is a significant risk factor for behavioral problems in very low birth weight infants (VLBWI). These issues, including emotional and aggressive behaviors, persist into preschool age, independent of cognitive development.
Area of Science:
- Neonatal Medicine
- Developmental Psychology
- Pediatric Neurology
Background:
- Preterm infants, particularly very low birth weight infants (VLBWI), face a high risk of behavioral problems later in life.
- The specific risk factors and origins of these behavioral issues in VLBWI remain incompletely understood.
- Neonatal intensive care improvements have not fully mitigated the long-term behavioral challenges in this vulnerable population.
Purpose of the Study:
- To investigate neonatal sepsis as a potential risk factor for adverse behavioral outcomes in very low birth weight infants (VLBWI) at preschool age.
- To analyze the association between culture-proven neonatal sepsis and behavioral problems at five years of age.
- To identify other contributing factors to behavioral issues in VLBWI.
Main Methods:
- Retrospective observational study analyzing 312 VLBWI born at <32 weeks gestational age.
- Behavioral outcomes assessed at 5 years using the Child Behavior Checklist (CBCL).
- Multivariable regression model used, controlling for neonatal morbidities, socioeconomic status, and neurodevelopmental outcome.
Main Results:
- 11% of VLBWI experienced neonatal sepsis.
- Neonatal sepsis was a significant risk factor for both internalizing (emotional reactivity, anxiety/depression) and externalizing (oppositional, aggressive behavior) problems.
- Low socioeconomic status and male gender were also significant risk factors for behavioral problems.
- No differences in neurocognitive development were found between infants with and without sepsis.
Conclusions:
- Very low birth weight infants are susceptible to various behavioral disorders, irrespective of cognitive development.
- Neonatal morbidities, particularly neonatal sepsis, significantly impact the behavioral outcomes of VLBWI.
- Both neonatal factors and postnatal environment contribute to behavioral development in VLBWI, challenging previous assumptions focused solely on the postnatal environment.
Objective:
This study aimed to investigate neonatal sepsis as potential risk factor for adverse behavioral outcome in very low birth weight infants (VLBWI) at preschool age. Regardless of improvements in the obstetric and neonatal intensive care, preterm infants are still at high risk for behavioral problems later in life. The spectrum, origin and potential risk factors of these behavioral problems have not been well-defined.
Methods:
In this retrospective observational study, the influence of culture-proven neonatal sepsis on the behavioral outcome of VLBWI born at a gestational age <32 weeks was analyzed at 5 years of age in a multivariable regression model. Behavior was assessed with the Child Behavior Checklist (CBCL). Neonatal morbidities, socioeconomic status and neurodevelopmental outcome served as covariates in the analysis.
Results:
312 VLBWI entered the final analysis, of whom 11% had experienced neonatal sepsis. Neonatal sepsis appeared to be a relevant risk factor for both internalizing, i.e., emotional reactivity and anxiety/depression, as well as externalizing behavioral problems, i.e., oppositional and aggressive behavior in this cohort of VLBWI. Low socioeconomic status and male gender were additional statistically significant risk factors for both internalizing and externalizing behavioral problems. No difference in neurocognitive development was observed between the groups.
Conclusion:
The study supports the fact that VLBWI are vulnerable to multiple behavioral disorders independent of their cognitive development. In contrast to former assumptions, the results of the study emphasize that not only post-natal environment but also neonatal morbidities, especially neonatal sepsis, have an impact on behavioral outcome of VLBWI at preschool age.
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