Document Detail


Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection.
MedLine Citation:
PMID:  15547163     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Neonatal infections are frequent complications of extremely low-birth-weight (ELBW) infants receiving intensive care.
OBJECTIVE: To determine if neonatal infections in ELBW infants are associated with increased risks of adverse neurodevelopmental and growth sequelae in early childhood.
DESIGN, SETTING, AND PARTICIPANTS: Infants weighing 401 to 1000 g at birth (born in 1993-2001) were enrolled in a prospectively collected very low-birth-weight registry at academic medical centers participating in the National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth outcomes were assessed at a comprehensive follow-up visit at 18 to 22 months of corrected gestational age and compared by infection group. Eighty percent of survivors completed the follow-up visit and 6093 infants were studied. Registry data were used to classify infants by type of infection: uninfected (n = 2161), clinical infection alone (n = 1538), sepsis (n = 1922), sepsis and necrotizing enterocolitis (n = 279), or meningitis with or without sepsis (n = 193).
MAIN OUTCOME MEASURES: Cognitive and neuromotor development, neurologic status, vision and hearing, and growth (weight, length, and head circumference) were assessed at follow-up.
RESULTS: The majority of ELBW survivors (65%) had at least 1 infection during their hospitalization after birth. Compared with uninfected infants, those in each of the 4 infection groups were significantly more likely to have adverse neurodevelopmental outcomes at follow-up, including cerebral palsy (range of significant odds ratios [ORs], 1.4-1.7), low Bayley Scales of Infant Development II scores on the mental development index (ORs, 1.3-1.6) and psychomotor development index (ORs, 1.5-2.4), and vision impairment (ORs, 1.3-2.2). Infection in the neonatal period was also associated with impaired head growth, a known predictor of poor neurodevelopmental outcome.
CONCLUSIONS: This large cohort study suggests that neonatal infections among ELBW infants are associated with poor neurodevelopmental and growth outcomes in early childhood. Additional studies are needed to elucidate the pathogenesis of brain injury in infants with infection so that novel interventions to improve these outcomes can be explored.
Authors:
Barbara J Stoll; Nellie I Hansen; Ira Adams-Chapman; Avroy A Fanaroff; Susan R Hintz; Betty Vohr; Rosemary D Higgins;
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA     Volume:  292     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-11-19     Completed Date:  2004-11-24     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2357-65     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Cerebral Palsy / epidemiology,  etiology
Cohort Studies
Developmental Disabilities / epidemiology,  etiology*
Enterocolitis, Necrotizing / complications
Female
Growth
Hearing Loss / epidemiology,  etiology
Humans
Infant
Infant, Newborn
Infant, Premature, Diseases*
Infant, Very Low Birth Weight* / growth & development
Infection / complications
Male
Meningitis / complications
Sepsis / complications*
Vision Disorders / epidemiology,  etiology
Grant Support
ID/Acronym/Agency:
U01 HD19897/HD/NICHD NIH HHS; U01 HD36790/HD/NICHD NIH HHS; U10 HD21364/HD/NICHD NIH HHS; U10 HD21373/HD/NICHD NIH HHS; U10 HD21385/HD/NICHD NIH HHS; U10 HD21397/HD/NICHD NIH HHS; U10 HD21415/HD/NICHD NIH HHS; U10 HD27851/HD/NICHD NIH HHS; U10 HD27853/HD/NICHD NIH HHS; U10 HD27856/HD/NICHD NIH HHS; U10 HD27871/HD/NICHD NIH HHS; U10 HD27880/HD/NICHD NIH HHS; U10 HD27881/HD/NICHD NIH HHS; U10 HD27904/HD/NICHD NIH HHS; U10 HD34167/HD/NICHD NIH HHS; U10 HD34216/HD/NICHD NIH HHS; U10 HD40461/HD/NICHD NIH HHS; U10 HD40492/HD/NICHD NIH HHS; U10 HD40498/HD/NICHD NIH HHS; U10 HD40521/HD/NICHD NIH HHS; U10 HD40689/HD/NICHD NIH HHS
Comments/Corrections
Comment In:
JAMA. 2005 Feb 23;293(8):932; author reply 932   [PMID:  15728163 ]
JAMA. 2004 Nov 17;292(19):2399-401   [PMID:  15547169 ]

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