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 incre...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.展开更多
Objectives. Necrotizing enterocolitis (NEC) is a significant complication for the premature infant. However, subsequent neurodevelopmental and growth outcomes of extremely low birth weight (ELBW) infants with NEC have...Objectives. Necrotizing enterocolitis (NEC) is a significant complication for the premature infant. However, subsequent neurodevelopmental and growth outcomes of extremely low birth weight (ELBW) infants with NEC have not been well described. We hypothesized that ELBW infants with surgically managed (SurgNEC) are at greater risk for poor neurodevelopmental and growth outcomes than infants with medically managed NEC (MedNEC) compared with infants without a history of NEC (NoNEC). The objective of this study was to compare growth, neurologic, and cognitive outcomes among ELBW survivors of Surg NEC and MedNEC with NoNEC at 18 to 22 months’corrected age. Methods. Multicenter, retrospective analysis was conducted of infants who were born between January 1, 1995, and December 31, 1998, and had a birth weight < 1000 g in the National Institute of Child Health and Human Development Neonatal Research Network Registry. Neurodevelopment and growth were assessed at 18 to 22 months’postmenstrual age. χ2, t test, and logistic regression analyses were used. Results. A total of 2948 infants were evaluated at 18 to 22 months, 124 of whom were SurgNEC and 121 of whom were MedNEC. Compared with NoNEC, both SurgNEC and MedNEC infants were of lower birth weight and had a greater incidence of late sepsis; SurgNEC but not MedNEC infants were more likely to have received a diagnosis of cystic periventricular leukomalacia and bronchopulmonary dysplasia and been treated with postnatal steroids. Weight, length, and head circumference < 10 percentile at 18 to 22 months were significantly more likely among Surg NEC but not MedNEC compared with NoNEC infants. After correction for anthropometric measures at birth and adjusted age at follow-up, all growth parameters at 18 to 22 months for Surg NEC but not Med-NEC infants were significantly less than for NoNEC infants. Surg NEC but not Med NEC was a significant independent risk factor for Mental Developmental Index < 70 (odds ratio [OR]: 1.61; 95%confidence interval [CI]: 1.05-2.50), Psychomotor Developmental Index < 70 (OR: 1.95; 95%CI: 1.25-3.04), and neurodevelopmental impairment (OR: 1.78; 95%CI: 1.17-2.73) compared with NoNEC. Conclusions. Among ELBW infants, SurgNEC is associated with significant growth delay and adverse neurodevelopmental outcomes at 18 to 22 months’corrected age compared with NoNEC.MedNEC does not seem to confer additional risk. Surg NEC is likely to be associated with greater severity of disease.展开更多
文摘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.
文摘Objectives. Necrotizing enterocolitis (NEC) is a significant complication for the premature infant. However, subsequent neurodevelopmental and growth outcomes of extremely low birth weight (ELBW) infants with NEC have not been well described. We hypothesized that ELBW infants with surgically managed (SurgNEC) are at greater risk for poor neurodevelopmental and growth outcomes than infants with medically managed NEC (MedNEC) compared with infants without a history of NEC (NoNEC). The objective of this study was to compare growth, neurologic, and cognitive outcomes among ELBW survivors of Surg NEC and MedNEC with NoNEC at 18 to 22 months’corrected age. Methods. Multicenter, retrospective analysis was conducted of infants who were born between January 1, 1995, and December 31, 1998, and had a birth weight < 1000 g in the National Institute of Child Health and Human Development Neonatal Research Network Registry. Neurodevelopment and growth were assessed at 18 to 22 months’postmenstrual age. χ2, t test, and logistic regression analyses were used. Results. A total of 2948 infants were evaluated at 18 to 22 months, 124 of whom were SurgNEC and 121 of whom were MedNEC. Compared with NoNEC, both SurgNEC and MedNEC infants were of lower birth weight and had a greater incidence of late sepsis; SurgNEC but not MedNEC infants were more likely to have received a diagnosis of cystic periventricular leukomalacia and bronchopulmonary dysplasia and been treated with postnatal steroids. Weight, length, and head circumference < 10 percentile at 18 to 22 months were significantly more likely among Surg NEC but not MedNEC compared with NoNEC infants. After correction for anthropometric measures at birth and adjusted age at follow-up, all growth parameters at 18 to 22 months for Surg NEC but not Med-NEC infants were significantly less than for NoNEC infants. Surg NEC but not Med NEC was a significant independent risk factor for Mental Developmental Index < 70 (odds ratio [OR]: 1.61; 95%confidence interval [CI]: 1.05-2.50), Psychomotor Developmental Index < 70 (OR: 1.95; 95%CI: 1.25-3.04), and neurodevelopmental impairment (OR: 1.78; 95%CI: 1.17-2.73) compared with NoNEC. Conclusions. Among ELBW infants, SurgNEC is associated with significant growth delay and adverse neurodevelopmental outcomes at 18 to 22 months’corrected age compared with NoNEC.MedNEC does not seem to confer additional risk. Surg NEC is likely to be associated with greater severity of disease.
