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Non-Invasive Model of Neuropathogenic Escherichia coli Infection in the Neonatal Rat

Non-Invasive Model of Neuropathogenic Escherichia coli Infection in the Neonatal Rat

Published on: October 29, 2014

Neurodevelopmental outcomes following possible serious bacterial infection in early infancy in Karachi, Pakistan: a

Nudrat Farheen¹, Shahira Shahid¹, Kiran Ramzan Ali Lalani¹

¹Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.

|May 15, 2024

Insights

Early infancy infections in Pakistan are linked to significant neurodevelopmental challenges in children, including delayed milestones and motor skill deficits. These findings underscore the need for continued monitoring and support for affected children.

Area of Science:

Pediatric Health
Neurodevelopmental Pediatrics
Infectious Diseases Epidemiology

Background:

Neonatal infections pose a major threat to child survival and development in Pakistan.
Understanding the long-term neurodevelopmental consequences of early infections is crucial for public health interventions.

Purpose of the Study:

To evaluate the long-term effects of early infancy infections on neurodevelopmental outcomes in children.
To compare neurodevelopmental assessments of children with and without a history of serious bacterial infections in infancy.

Main Methods:

A prospective follow-up study was conducted in Karachi, Pakistan, involving children aged 6-9 years.
Neurodevelopmental assessments used included the Ten Questions (TQS) questionnaire, Strengths and Difficulties Questionnaire (SDQ), and PEDS: DM-AL.
Generalized Structural Equation Modelling (GSEM) analyzed associations between developmental milestones, anthropometry, and sociodemographic factors.

Main Results:

Children with early serious bacterial infections (pSBI) showed higher rates of abnormal TQS scores (54.5% vs. 35.0%) and motor delays (21.2% vs. 12.1%).
Lower fine motor skills were observed in the pSBI group (78.4 vs. 83.2).
Early pSBI exposure was associated with delayed TQS milestones, poorer fine motor skills, and reduced anthropometric measurements.

Conclusions:

Early infancy infections are associated with adverse neurodevelopmental outcomes, including motor and fine motor skill deficits, in Pakistani children.
Socioeconomic factors and healthcare access compound these challenges.
Integrated, long-term follow-up care including neurodevelopmental assessments is essential for children with a history of early infections.

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Abstract

Background:

Pakistan reports a significant burden of neonatal mortality, with infections as one of the major causes. We aim to assess the long-term impact of early infancy infections on neurodevelopmental outcomes during later childhood.

Methods:

We conducted a prospective follow-up study of the cohort enrolled at the Karachi site of the Aetiology of Neonatal Infection in South Asia (ANISA) during 2019-2020. Children with a possible serious bacterial infection (based on the WHO IMCI algorithm) at early infancy were assessed for neurodevelopment at 6-9 years of age and compared with healthy controls. The Ten Questions (TQS) questionnaire, Strengths and Difficulties Questionnaire (SDQ), and Parent's Evaluation of Developmental Stage Assessment Level (PEDS: DM-AL) neurodevelopmental assessment tools, were administered and scored by the research staff who were blinded to the child's exposure status. Generalized Structural Equation Modelling (GSEM) was employed to verify relationships and associations among developmental milestones, anthropometry, and sociodemographic variables.

Results:

A total of 398 children (241 cases and 157 controls) completed neurodevelopmental and growth assessments. Cases had a significantly higher rate of abnormal TQS scores (54.5% vs. 35.0%, p-value 0.001), greater delays in motor milestones (21.2% vs. 12.1%, p-value 0.02), lower fine motor skills (78.4 ± 1.4 vs. 83.2 ± 1.5, p-value 0.02). The receptive language skills were well-developed in both groups. According to the logistic regression model, exposure to infection during the first 59 days of life was associated with delayed TQS milestones (β = -0.6, 95% CI -1.2,-0.04), TQS hearing domain (β = -0.3, 95% CI: -1.2 to 0.7), PEDS: DM-AL fine motor domain (β = -1.3, 95% CI: -4.4 to 1.7), PEDS: DM-AL receptive language development (β = -1.1, 95% CI: -3.7 to 1.4) and child anthropometric measurements such as weight and height (β = -0.2, 95% CI: -0.4 to 0.01 and β = -0.2, 95% CI: -0.4 to -0.01, respectively). Early pSBI exposure was positively associated with PEDS: DM-AL self-help domain (β = 0.6, 95% CI: -1.2 to 2.4) and SDQ-P overall score (β = 0.02, 95% CI: -0.3 to 0.3).

Conclusion:

Children exposed to PSBI during early infancy have higher rates of abnormal development, motor delays, and lower fine motor skills during later childhood in Pakistan. Socioeconomic challenges and limited healthcare access contribute to these challenges, highlighting the need for long-term follow-ups with integrated neurodevelopment assessments.

Keywords:

Childhood Neurodevelopment Newborns Pakistan Possible serious bacterial infection Young infants

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