Elsevier

The Journal of Pediatrics

Volume 153, Issue 2, August 2008, Pages 170-175.e1
The Journal of Pediatrics

Original article
Adverse Neurodevelopment in Preterm Infants with Postnatal Sepsis or Necrotizing Enterocolitis is Mediated by White Matter Abnormalities on Magnetic Resonance Imaging at Term

https://doi.org/10.1016/j.jpeds.2008.02.033Get rights and content

Objectives

To test the hypothesis that the impact of postnatal sepsis/necrotizing enterocolitis (NEC) on neurodevelopment may be mediated by white matter abnormality (WMA), which can be demonstrated with magnetic resonance imaging (MRI).

Study design

A prospective cohort of 192 unselected preterm infants (gestational age <30 weeks), who were evaluated for sepsis and NEC, underwent imaging at term-equivalent age and neurodevelopmental outcome at 2 years corrected age with the Bayley Scales of Infant Development.

Results

Sixty-eight preterm (35%) infants had 100 episodes of confirmed sepsis, and 9 (5%) infants had confirmed NEC. Coagulase-negative staphylococci accounted for 73% (73/100) of the episodes of confirmed sepsis. Infants with sepsis/NEC had significantly more WMA on MRI at term compared with infants in the no-sepsis/NEC group. They also had poorer psychomotor development that persisted after adjusting for potential confounders but which became nonsignificant after adjusting for WMA.

Conclusions

Preterm infants with sepsis/NEC are at greater risk of motor impairment at 2 years, which appears to be mediated by WMA. These findings may assist in defining a neuroprotective target in preterm infants with sepsis/NEC.

Section snippets

Subjects

Infants born before 30 weeks' gestation and admitted to the Royal Women's Hospital, Melbourne, Australia, between April 2001 and December 2003 were recruited for a prospective cohort MRI study. Two hundred and eight infants were recruited, which represents 67% of all eligible infants. Four of these were excluded because of congenital and chromosomal abnormalities. For the remaining infants (n = 204) there were no significant differences in the perinatal or postnatal characteristics of the

Cohort Characteristics

Of the 204 eligible infants, MRI images were not available for 3 infants, and for 9 infants follow-up was not possible because 2 infants had died, 1 infant had moved overseas, and 6 families either refused further participation or had withdrawn consent. Of the 2 infants who died, 1 had 3 episodes of confirmed sepsis with coagulase-negative staphylococci (CONS) and also had NEC requiring surgery, and the other had no episodes of confirmed sepsis or NEC. In relation to the remaining 10 infants

Discussion

We found that sepsis/NEC in the premature infant is associated with a higher prevalence and severity of WMA on MRI at term-equivalent age. Subgroups of infants with CONS, which accounted for 73% of sepsis episodes, infants with any confirmed sepsis and infants with NEC all had elevated rates of WMA compared with infants in the no-sepsis/NEC group. However, only infants with NEC had substantially higher rates of GMA. This study also demonstrated that premature infants with sepsis/NEC had delayed

Acknowledgments

We are grateful to Mr. Michael Keane and the MRI Department at the Royal Children's Hospital in Melbourne, Australia for assistance with MRI. We are grateful to Ms. Kelly Howard, Ms. Karli Trevaud for assisting with neurodevelopmental assessments, Dr. Peter Filan, Dr. Noni Davis, and Dr. Geoff Ford for the medical assessments for the children, and Ms. Kate Callanan for assistance with coordinating follow-up. We wish to acknowledge the Murdoch Children's Research Institute and grant support from

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