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Recurrent Late-Onset Sepsis in Extremely Low Birth Weight Infants Is Associated with Motor Deficits in Early School
Alexander Humberg1, Mats Ingmar Fortmann1, Juliane Spiegler2
1Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
Insights
Extremely low birth weight infants surviving recurrent late-onset sepsis (LOS) face higher risks of adverse motor development. This study highlights the motor development impact of sepsis in high-risk preterm infants.
Area of Science:
- Neonatal neurology
- Pediatric infectious diseases
- Developmental pediatrics
Background:
- Sepsis is a known risk factor for brain injury in preterm infants.
- Extremely low birth weight infants (ELBWI) are particularly vulnerable to sepsis.
- Recurrent late-onset sepsis (LOS) may significantly impact long-term neurodevelopmental outcomes in ELBWI.
Purpose of the Study:
- To investigate the association between recurrent LOS and long-term neurodevelopmental outcomes in ELBWI.
- To evaluate the impact of sepsis episodes on motor, cognitive, and behavioral development at 5-6 years of age.
Main Methods:
- A large multicenter observational study included ELBWI born at ≤28 6/7 weeks gestation.
- Neurodevelopment, behavior, and motor skills were assessed by blinded investigators at 5-6 years.
- Univariate and logistic regression analyses were used to evaluate the impact of recurrent LOS.
Main Results:
- Recurrent sepsis was significantly associated with adverse motor development (pB = 0.012).
- Infants with recurrent LOS had 1.7 times higher odds of critical motor testing results compared to those with one LOS.
- No significant impact of recurrent LOS was found on intelligence quotient or behavioral difficulties.
Conclusions:
- Recurrent sepsis in preterm infants is linked to poorer long-term motor development.
- While recurrent infections correlate with adverse motor outcomes, other preterm-related complications may also contribute to neurodevelopmental differences.
Introduction:
Sepsis is regarded as a risk factor for brain injury in preterm infants. We herein hypothesize that extremely low birth weight infants (ELBWI, birth weight <1,000 g) having survived recurrent blood culture-proven late-onset sepsis (LOS) episodes are more likely to have an adverse long-term neurologic outcome.
Methods:
In a large multicenter observational study of ELBWI ≤28 6/7 weeks, we evaluated the impact of recurrent LOS (blood culture-proven, after day 7 of life) on development at 5-6 years. Neurodevelopment, behavior, and motor qualities were tested by blinded investigators. Univariate and logistic regression analyses were performed.
Results:
The cohort consisted of 1343 ELBWI including 1,080 infants without LOS, 186 infants with one LOS, and 77 with recurrent LOS, i.e., 55 infants with two and 22 infants with three LOS episodes. After Bonferroni-Holm correction, multiple logistic regression analysis revealed recurrent sepsis to be significantly associated with adverse motor development (critical MABC-2 testing: 3.3 [1.5-7.3], p = 0.003, pB = 0.012), whereas no significant impact of recurrent LOS was found on intelligence quotient and behavioral difficulties. Odds of having critical motor testing results for infants with recurrent LOS were 1.7 times (95% confidence interval 1.4-2.3) that of infants with one LOS.
Conclusion:
Recurrent sepsis in preterm infants is associated with adverse long-term motor development. However, infants with recurrent infections are also more likely to have preterm-related complications, and reasons for a worse neurodevelopmental outcome remain to be elucidated.
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