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Published on: November 20, 2015
Long-term impact of serious neonatal bacterial infections on neurodevelopment
Reenu Thomas1, Merijn W Bijlsma2, Bronner P Gonçalves3
1Department of Pediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Neonatal bacterial infections can cause long-term neurodevelopmental issues. More research is needed, especially in low-income countries, to understand and address these consequences.
Area of Science:
- Neonatal research
- Neuroscience
- Infectious disease epidemiology
Background:
- Neonatal bacterial infections are a major cause of infant mortality and morbidity.
- Long-term neurodevelopmental consequences of these infections are not well understood.
- Understanding these sequelae is crucial for public health.
Purpose of the Study:
- To review evidence on the causes, diagnosis, and frequency of long-term problems after neonatal bacterial sepsis and meningitis.
- To discuss future research needs for quantifying the public health impact.
- To explore mechanisms of brain injury and identify risk factors.
Main Methods:
- Literature review of mechanistic and epidemiological studies.
- Analysis of studies on long-term sequelae in children with and without neonatal infection history.
- Review of tools for assessing neurodevelopmental impairment.
Main Results:
- Mechanisms of brain injury include direct and indirect pathways.
- Epidemiological data on the frequency of neurodevelopmental impairment is limited.
- Risk factors for poor outcomes have been described.
Conclusions:
- Current studies are insufficient due to limited scope, variable methods, and focus on high-income settings.
- Multi-country studies with long-term follow-up and standardized diagnostics are essential.
- Research is particularly needed in low and middle-income countries with high sepsis incidence.
Background:
Neonatal bacterial infections have long been recognized as an important cause of acute morbidity and mortality, but long-term neurodevelopmental consequences have not been comprehensively described and discussed.
Objectives:
We aimed to summarize evidence on the pathogenesis, diagnosis, and epidemiology of long-term sequelae after neonatal bacterial sepsis and meningitis. We also discuss approaches for future studies to quantify the public health impact of neonatal infection-associated neurodevelopmental impairment.
Sources:
We identified studies, both research articles and reviews, which provide mechanistic information on the long-term disease, as well as epidemiological studies that describe the frequency of neurodevelopmental impairment in children with and, for comparison, without a history of neonatal bacterial infection. Tools currently used in clinical practice and research settings to assess neurodevelopmental impairment were also reviewed.
Content:
We first enumerate potential direct and indirect mechanisms that can lead to brain injury following neonatal infections. We then discuss summary data, either frequencies or measures of association, from epidemiological studies. Risk factors that predict long-term outcomes are also described. Finally, we describe clinical approaches for identifying children with neurodevelopmental impairment and provide an overview of common diagnostic tools.
Implications:
The limited number of studies that describe the long-term consequences of neonatal infections, often undertaken in high-income settings and using variable designs and diagnostic tools, are not sufficient to inform clinical practice and policy prioritization. Multi-country studies with follow-up into adolescence, standardized diagnostic approaches, and local comparator groups are needed, especially in low and middle-income countries where the incidence of neonatal sepsis is high.
