The registry data were used to classify infants by type of infection, including uninfected (2,161); clinical infection alone (1,538); sepsis (1,922); sepsis and necrotizing enterocolitis (279); or meningitis with or without sepsis (193). Sepsis is an infection of the bloodstream, and necrotizing enterocolitis (NEC) is a severe intestinal disease linked to infection.
Overall, 41 percent of the assessed infants had at least one adverse neurodevelopmental outcome. Infants without infection were least likely to have adverse outcomes, while those with sepsis/NEC were most likely. Overall, 62 percent of the infants had weight, length, or head circumferences less than the 10th percentile. Significant differences for all the neurodevelopmental outcomes except hearing impairment were found between children in most infection groups and the uninfected group. Only infants who had sepsis or sepsis/NEC were at increased risk of hearing impairment.
The investigators considered several possible reasons for the detrimental effects of infections of neonatal infections on the brains of newborns. An inflammatory response by immune signaling proteins called cytokines, either in the fetus or amniotic fluid, reflecting an infection in utero, appears to increase the risk for neonatal brain injury. Newborns with infections also are at risk for circulatory or respiratory problems that could contribute to difficulties with regulation of blood flow in the brain. Interventions to reduce brain injury associated with infection could include earlier diagnosis, efforts to stabilize blood pressure and maintain adequate oxygen supply, and therapies to reduce systemic inflammation.
"As the mortality rate for extremely-low-birth-rate infants continues to decrease, we are increasing our efforts to assess and improve the long-term outcomes associated with prematurity," Dr. Stoll said. "Additional studies will be important to fin
Contact: Holly Korschun
Emory University Health Sciences Center