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The impact of prenatal and neonatal infection on neurodevelopmental outcomes in very preterm infants

Journal of Perinatology volume 34, pages 741–747 (2014)Cite this article

Subjects

Abstract

Objective:

Determine the association of prenatal and neonatal infections with neurodevelopmental outcomes in very preterm infants.

Study Design:

Secondary retrospective analysis of 155 very preterm infants at a single tertiary referral center. General linear or logistic regression models were used to evaluate the association with hospital factors; brain injury, growth and development; and neurobehavioral outcome.

Result:

Necrotizing enterocolitis with sepsis was associated with reduced transcerebellar diameter (38.3 vs 48.4 mm, P<0.001) and increased left ventricular diameter (12.0 vs 8.0 mm, P=0.005). Sepsis alone was associated with higher diffusivity in the left frontal lobe (1.85 vs 1.68 × 10−3 mm2 s−1, P=0.001) and right cingulum bundle (1.52 vs 1.45 × 10−3 mm2 s−1, P=0.002). Neurobehavioral outcomes were worse in children exposed to maternal genitourinary infection (cognitive composite: β=−8.8, P=0.001; receptive language score: β=−2.7, P<0.001; language composite: β=−14.9, P<0.001) or histological chorioamnionitis (language composite: β=−8.6, P=0.006), but not neonatal infection.

Conclusion:

Neonatal infection was associated with changes in brain structure but not with neurobehavioral outcomes, whereas the opposite pattern was observed for maternal genitourinary tract infection. These findings emphasize the potential importance of infections during pregnancy on the neurodevelopmental outcomes of preterm infants.

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Acknowledgements

We wish to acknowledge those who assisted in acquiring, processing or reading MRI and US scans at Washington University in St Louis, including Karen Lukas, Joe Ackerman, Tara Smyser, Jeanette Kenley and Eilon Shany (visiting from Soroka University Medical Center, Israel). We are grateful for the advice on statistical processing from Mike Wallendorf and editing from Deborah Frank (both at Washington University in St Louis). This work is financially supported by National Institute of Health (NICHD) R01HD05805, P30HD062171 and the Doris Duke Foundation Distinguished Clinical Scientist Award to Dr Inder. This work was also supported by a grant from the Doris Duke Charitable Foundation to Washington University in St Louis for Clinical Research Fellow IL. Dr Rogers is supported by Grant Number UL1 TR000448 and TL1 TR000449/ KL2 TR000450 from the NIH-National Center for Research Resources (NCRR) and the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health. Dr Symser is supported by the Child Neurology Foundation, NIH K12 NS001690 and UL1 TR000448. Dr Mysorekar is supported by the Preventing Prematurity Initiative grant from the Burroughs Wellcome Fund.

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Authors and Affiliations

  1. Department of Pediatrics, Washington University, St Louis, MO, USA,

    I Lee, J J Neil, C D Smyser, H Kidokoro & T E Inder

  2. Department of Neurology, Washington University, St Louis, MO, USA,

    J J Neil, C D Smyser & T E Inder

  3. Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA,

    J J Neil, J S Shimony & T E Inder

  4. Department of Pathology and Immunology, Washington University, St Louis, MO, USA,

    P C Huettner

  5. Department of Psychiatry, Washington University, St Louis, MO, USA,

    C E Rogers

  6. Department of Obstetrics and Gynecology, Washington University, St Louis, MO, USA,

    I U Mysorekar

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  1. I Lee
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Correspondence to T E Inder.

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Lee, I., Neil, J., Huettner, P. et al. The impact of prenatal and neonatal infection on neurodevelopmental outcomes in very preterm infants. J Perinatol 34, 741–747 (2014). https://doi.org/10.1038/jp.2014.79

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