Article

Perinatal Infections and Neurodevelopmental Outcome in Very Preterm and Very Low-Birth-Weight Infants A Meta-Analysis

JAMA pediatrics 05/2013; 167(7):1-7. DOI: 10.1001/jamapediatrics.2013.1199
Source: PubMed

ABSTRACT

IMPORTANCE Perinatal infections are commonly present in preterm and very low-birth-weight (VLWB) infants and might contribute to adverse neurodevelopmental outcome. OBJECTIVE To summarize studies evaluating the effect of perinatal infections on neurodevelopmental outcome in very preterm/VLBW infants. EVIDENCE REVIEW On December 12, 2011, we searched Medline, PsycINFO, Embase, and Web of Knowledge for studies on infections and neurodevelopmental outcome. All titles and abstracts were assessed for eligibility by 2 independent reviewers. We also screened the reference lists of identified articles to search for additional eligible studies. Preselected criteria justified inclusion in this meta-analysis: (1) the study included infants born very preterm (≤32 weeks) and/or with VLBW (≤1500 g); (2) the study compared infants with and without perinatal infection; (3) there was follow-up using the Bayley Scales of Infant Development 2nd edition; and (4) results were published in an English-language peer-reviewed journal. The quality of each included study was assessed using the Newcastle-Ottawa Scale. FINDINGS This meta-analysis includes 18 studies encompassing data on 13.755 very preterm/VLBW infants. Very preterm/VLBW infants with perinatal infections had poorer mental (d = -0.25; P < .001) and motor (d = -0.37; P < .001) development compared with very preterm/VLBW infants without infections. Mental development was most impaired by necrotizing enterocolitis (d = -0.40; P < .001) and meningitis (d = -0.37; P < .001). Motor development was most impaired by necrotizing enterocolitis (d = -0.66; P < .001). Chorioamnionitis did not affect mental (d = -0.05; P = .37) or motor (d = 0.19; P = .08) development. CONCLUSIONS AND RELEVANCE Postnatal infections have detrimental effects on mental and motor development in very preterm/VLBW infants.

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Available from: Ruurd Van Elburg, Nov 18, 2015
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    • "With regards to perinatal variables, it is well known that lower birthweight and gestational age are significantly associated with higher rates of cognitive and language impairments, as well as greater prevalence of behavior problems [5]. Studies also have demonstrated that neonatal illness, such as bronchopulmonary dysplasia (BPD) [20] [21], intraventricular hemorrhage (IVH) [22] [23], and necrotizing enterocolitis [24] are significantly related to neurodevelopmental deficits. "
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    ABSTRACT: Background: Very low birthweight (VLBW) premature infant follow-up studies report on single developmental outcome variables but do not assess profiles of development. Aims: To identify developmental profiles of VLBW premature infants based on cognitive and language development and their association with demographic, perinatal, and behavior variables. Study design: Retrospective chart review. Subjects: 117 children<1250g BW seen at 18months post-term on the Bayley Scales-III and Child Behavior Checklist 1 ½-5 (CBCL 1 ½-5), a behavior problem questionnaire. Demographic and perinatal variables were obtained from medical records. Outcome measures: Bayley Cognitive, Expressive Language, and Receptive Language scores were used to cluster the subjects into developmental profiles. Demographic, perinatal, and CBCL variables were analyzed as they related to clusters. Results: Children were clustered into 4 groups based on their Bayley Cognitive, Expressive Language, and Receptive Language scores: Consistently High, Consistently Average, Average with Delayed Expressive Language, and Consistently Low. Socioeconomic status, bronchopulmonary dysplasia, Grades III-IV intraventricular hemorrhage, and summary Behavior Problems and Attention Deficit/Hyperactivity (ADHD) Problems scores were significantly related to clusters. Conclusion: Cluster analysis defined distinct outcome groups in VLBW premature children and provides an informative means of identifying factors related to developmental outcome. This approach may be useful in predicting later outcome and determining which groups of children will require early intervention.
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    • "Consequently, abnormal WM development in these regions may be useful for identifying infants with higher risk for adverse outcomes. Known risk factors for poor neurodevelopment following preterm birth include sepsis (Stoll et al., 2002; Schlapbach et al., 2011; Hentges et al., 2013; Mitha et al., 2013), bronchopulmonary dysplasia (Schmidt et al., 2003; Vohr et al., 2005; Karagianni et al., 2011; Schlapbach et al., 2012), necrotizing enterocolitis (NEC) (Hintz et al., 2005; van Vliet et al., 2013), and male sex (Wood et al., 2005; Vohr et al., 2005; Rose et al., 2009; Beaino et al., 2010; Morsing et al., 2011). The aim of this study was to examine the relationship between neonatal physiological risk factors and early brain microstructure in VLBW preterm infants at near-term age, based on qualitative analysis of structural MRI and on semi-automated, atlas-based DTI analysis. "
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