Neonatal Infection and 5-year Neurodevelopmental Outcome of Very Preterm Infants

Author:

Mitha Ayoub123,Foix-L’Hélias Laurence23,Arnaud Catherine456,Marret Stéphane78,Vieux Rachel9,Aujard Yannick10,Thiriez Gérard11,Larroque Béatrice2312,Cambonie Gilles13,Burguet Antoine2314,Boileau Pascal15,Rozé Jean Christophe1617,Kaminski Monique23,Truffert Patrick118,Ancel Pierre-Yves23

Affiliation:

1. Neonatal Unit Hôpital Jeanne de Flandre, Lille, France;

2. Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S953, Epidemiological Research Unit on Perinatal Health and Women's and Children’s Health, Paris, France;

3. Université Pierre-et-Marie-Curie, Paris, France;

4. Institut National de la Santé et de la Recherche Médicale, Toulouse, France;

5. Paul-Sabatier University, Toulouse, France;

6. Centre Hospitalier Universitaire Purpan, Clinical Epidemiology Unit, Toulouse, France;

7. Department of Neonatal Medicine, Rouen University Hospital, Rouen, France;

8. Equipe Région-Institut National de la Santé et de la Recherche Médicale, ERI 28, NeoVasc, Institute for Biomedical Research and Innovation, Rouen University, Rouen, France;

9. Neonatal Unit Nancy University Hospital, Nancy, France;

10. NICU, Hopital Robert Debré, Assistance Publique Hopitaux de Paris et Université Paris Diderot, Paris, France;

11. Pediatrics Department, Besançon University Hospital, Franche-Comté University, Besançon, France;

12. Epidemiological and Clinical Research Unit, Beaujon Hospital, APHP, Clichy, France;

13. NICU and PICU Montpellier University Hospital, Hopital Arnaud de Villeneuve, Montpellier, France;

14. Department of Pediatrics, Hôpital du Bocage, Dijon, France;

15. Neonatal Unit, Centre Hospitalier Intercommunal Créteil, Université de Versailles Saint-Quentin, Poissy, France;

16. Department of Neonatology, Nantes University, Nantes, France;

17. Nantes University Institut National de la Santé et de la Recherche Médicale CIC004, Nantes, France; and

18. EA 9624 Epidemiological Research Unit on Quality of Care, Lille, France

Abstract

OBJECTIVE: To determine whether neonatal infections are associated with a higher risk of adverse neurodevelopment at 5 years of age in a population-based cohort of very preterm children. METHODS: We included all live births between 22 and 32 weeks of gestation, from 9 regions in France, in 1997 (EPIPAGE study). Of the 2665 live births, 2277 were eligible for a follow-up evaluation at 5 years of age: 1769 had a medical examination and 1495 underwent cognitive assessment. Cerebral palsy and cognitive impairment were studied as a function of early-onset sepsis (EOS) and late-onset sepsis (LOS), after adjustment for potential confounding factors, in multivariate logistic regression models. RESULTS: A total of 139 (5%) of the 2665 live births included in the study presented with EOS alone (without associated LOS), 752 (28%) had LOS alone (without associated EOS), and 64 (2%) displayed both EOS and LOS. At 5 years of age, the frequency of cerebral palsy was 9% (157 of 1769) and that of cognitive impairment was 12% (177 of 1495). The frequency of cerebral palsy was higher in infants with isolated EOS (odds ratio [OR]: 1.70 [95% confidence interval (CI): 0.84−3.45]) or isolated LOS (OR: 1.71 [95% CI: 1.14−2.56]) than in uninfected infants, and this risk was even higher in cases of combined EOS and LOS (OR: 2.33 [95% CI: 1.02−5.33]). There was no association between neonatal infection and cognitive impairment. CONCLUSIONS: Neonatal infections in these very preterm infants were associated with a higher risk of cerebral palsy at the age of 5 years, particularly in infants presenting with both EOS and LOS.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference42 articles.

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