Neonatal sepsis as a risk factor for neurodevelopmental changes in preterm infants with very low birth weight

Ferreira, Rachel C.; Mello, Rosane R.; Silva, Kátia S.

doi:10.1016/j.jpedp.2013.09.007

Article information

Abstract

Objective

to evaluate neonatal sepsis as a risk factor for abnormal neuromotor and cognitive development in very low birth weight preterm infants at 12 months of corrected age.

Methods

this was a prospective cohort study that followed the neuromotor and cognitive development of 194 very low birth weight preterm infants discharged from a public neonatal intensive care unit. The Bayley Scale of Infant Development (second edition) at 12 months of corrected age was used. The outcomes were the results of the clinical/neurological evaluation and the scores of the psychomotor development index (PDI) and mental development index (MDI) of the Bayley Scale of Infant Development II. The association between neonatal sepsis and neuromotor development and between neonatal sepsis and cognitive development was verified by logistic regression analysis.

Results

mean birth weight was 1,119g (SD: 247) and mean gestational age was 29 weeks and 6 days (SD: 2). Approximately 44.3% (n=86) of the infants had neonatal sepsis and 40.7% (n=79) had abnormal neuromotor development and/or abnormal psychomotor development index (PDI<85) at 12 months of corrected age. On the mental scale, 76 (39.1%) children presented abnormal cognitive development (MDI<85). Children with neonatal sepsis were 2.5 times more likely to develop changes in neuromotor development (OR: 2.50; CI: 1.23-5.10). There was no association between neonatal sepsis and cognitive development impairment.

Conclusion

neonatal sepsis was an independent risk factor for neuromotor development impairment at 12 months of corrected age, but not for mental development impairment.

Keywords:

Psychomotor performance

Child development

Sepsis

Premature

Risk factors

Infant

Follow-up

Resumo

Objetivo

avaliar a sepse neonatal como fator de risco para alterações no desenvolvimento neuromotor e mental de prematuros de muito baixo peso aos 12 meses de idade corrigida.

Métodos

estudo de coorte prospectivo que acompanhou o desenvolvimento neuromotor e mental de 194 prematuros de muito baixo peso oriundos de uma UTI neonatal pública no Rio de Janeiro. Utilizou-se a Escala Bayley de Desenvolvimento Infantil (segunda edição) aos 12 meses de idade corrigida. Os desfechos foram o resultado da avaliação clínica/neu- rológica e os resultados da área motora da Escala Bayley e os resultados da área mental (cognitiva) da mesma escala. A associação entre sepse e o desenvolvimento neuromotor e entre sepse e o desenvolvimento mental foi verificada através de regressão logística.

Resultados

a média do peso ao nascer foi 1119g (DP 247) e da idade gestacional 29 semanas e 6 dias (DP 2). Cerca de 44,3% (n=86) das crianças apresentaram sepse neo- natal e 40,7% (n=79) apresentaram alteração neuromotora e/ou no índice do desen- volvimento psicomotor (PDI<85) aos 12 meses de idade corrigida. Na escala mental, 76 (39,1%) crianças apresentaram alteração (MDI<85). As crianças que apresentaram sepse neonatal tiveram 2,5 vezes mais chances de desenvolver alteração do desenvolvimento neuromotor do que as crianças que não apresentaram sepse (OR: 2,50; IC 1,23-5,10). Porém, não houve associação entre sepse neonatal e alteração cognitiva.

Conclusão

a sepse neonatal foi um fator de risco independente para alteração do de- senvolvimento neuromotor, mas não para alteração do desenvolvimento mental.

Palavras-chave:

Desempenho psicomotor

Desenvolvimento infantil

Sepse

Prematuro

Fatores de risco

Lactente

Seguimento

Full text is only aviable in PDF

Referências

[1]

E. Miura, R.C. Silveira, R.S. Procianoy, Sepse Neonatal:.

diagnóstico e tratamento.

J Pediatr (Rio J)., 75 (1999), pp. S57-S62

[2]

A. Chapman, B.J. Stoll.

Neonatal infection and long-term neurdevelopmental outcome in the preterm infant.

Curr Opin Infect Dis., 19 (2006), pp. 290-297

http://dx.doi.org/10.1097/01.qco.0000224825.57976.87 | Medline

[3]

D. Bassler, B.J. Stoll, B. Schimidt, E.V. Asztalos, R.S. Roberts, C.M. Robertson, et al.

Using a count of neonatal morbities to predict poor outcome in extremely low birth infants: added role of neonatal infection.

Pediatrics, 123 (2009), pp. 313-318

http://dx.doi.org/10.1542/peds.2008-0377 | Medline

[4]

C.R. Martin, O. Dammann, E.N. Allred, S. Patel, T.M. O'Shea, K.C. Kuban, et al.

Neurodevelopment of extremely preterm infants who had necrotizing enterocolitis with or without late bacteremia.

J Pediatr., 157 (2010), pp. 751-756

http://dx.doi.org/10.1016/j.jpeds.2010.05.042 | Medline

[5]

D.K. Shah, L.W. Doyle, P.J. Anderson, M. Bear, A.J. Daley, R.W. Hunt, et al.

Adverse neurodevelopment in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term.

J Pediatr., 153 (2008), pp. 170-175

http://dx.doi.org/10.1016/j.jpeds.2008.02.033 | Medline

[6]

B.J. Stoll, N.I. Hansen, I.A. Chapman, A.A. Fanaroff, S.R. Hintz, B. Vohr, et al.

Neurodevelopmental and growth impairment among extremely low-birthweigth infants with neonatal infection.

JAMA., 292 (2004), pp. 2357-2365

http://dx.doi.org/10.1001/jama.292.19.2357 | Medline

[7]

T.R. Han, M.S. Bang, J.Y. Lim, B.H. Yoon, I.W. Kim.

Risk factors cerebral palsy in preterm infants.

Am J Phy Med Rehabil., 81 (2002), pp. 297-303

[8]

M. Wheater, J.M. Rennie.

Perinatal infection is na important risk factor for cerebral palsy in very-low-birthweight infants.

Dev Med Child Neurol., 42 (2000), pp. 364-367

Medline

[9]

U.K. Kohlendorfer, E. Ralser, U.P. Peglow, G. Reiter, R. Trawöger.

Adverse neurodevelopmental outcomes in preterm infants: risk factor profiles for different gestacional ages.

Acta Paediatr., 98 (2009), pp. 792-796

http://dx.doi.org/10.1111/j.1651-2227.2009.01219.x | Medline

[10]

L.J. Schlapbach, M. Aebischer, M. Adams, G. Natalucci, J. Bonhoeffer, P. Latzin, et al.

Impact of sepsis on neurodevelopmental outcome in a Swiss National Cohort of extremely premature infants.

Pediatrics., 128 (2011), pp. e349-e357

[11]

Agência Nacional de Vigilância Sanitária (ANVISA). Neonatologia: critérios nacionais de infecções relacionadas à assistência à saúde. 2a versão. 2010.

[12]

C.R. Hentges, R.C. Silveira, R.S. Procianoy, C.G. Carvalho, G.R. Filipouski, R.N. Fuentefria, et al.

Association of late-onset neonatal sepsis with late neurodevelopment in the first two years of life of preterm infants with very low birth weight.

J Pediatr (Rio J)., 90 (2013), pp. 50-57

[13]

J.L. Ballard, J.C. Khoury, K. Wedig, L. Wang, B.L. Eilers-Ealsman, R. Lipp.

New Ballard score, expanded to include extremely premature infants.

J Pediatr., 3 (1991), pp. 417-423

[14]

G.R. Alexander, J.H. Himes, R.B. Kaufman, J. Mor, M. Kogan.

A United States National Reference for fetal growth.

Obstet Gynecol., 87 (1996), pp. 163-168

http://dx.doi.org/10.1016/0029-7844(95)00386-X | Medline

[15]

R.L. Rodwell, A.L. Leslie, D.T. Tudehope.

Early diagnosis of neonatal sepsis using a hematologic scoring system.

J Pediatr., 112 (1988), pp. 761-767

Medline

[16]

C. Amiel Tyson, A. Grenier.

Neurological assessment during the first year of life.

Oxford University Press, (1986),

[17]

R.R. Mello, K.S. Silva, M.C. Rodrigues, G. Chalfun, R.C. Ferreira, J.V. Delamônica.

Predictive factors for neuromotor abnormalities at the corrected age of 12 Months in very low birth weight premature infants.

Arq Neuropsiquiatr., 67 (2009), pp. 235-241

Medline

[18]

Holt KS. Development in the first year. Em: Holt KS, editor. Child development-Diagnosis and assessment. London: Butterworth-Heinemann; 1991; p. 70-102.

[19]

W.K. Frankenburg, J.B. Dodds, P. Archer, H. Sharir.

Breusnich. The Denver II: a major revision and restandartization of the Denver developmental screening test. Pediatrics, 89 (1992), pp. 91-97

[20]

Bayley N. Bayley scales of infant development. 2a ed. San Antonio: Harcourt; 1993.

[21]

A.H. Jobe, E. Bancalari.

Bronchopulmonary dysplasia.

Am J Respir Crit Care Med., 163 (2001), pp. 1723-1729

http://dx.doi.org/10.1164/ajrccm.163.7.2011060 | Medline

[22]

M.J. Bell, J.L. Temberg, R.D. Feigin, J.P. Keating, R. Marshall, L. Barton, et al.

Neonatal necrotizant enterocolitis: therapeutic decisions based on clinical stating.

Ann Surg., 187 (1978), pp. 1-7

Medline

[23]

N.I. Miyague.

Persistência do canal arterial em recém-nascidos prematuros.

J Pediatr. (Rio J)., 6 (2005), pp. 429-430

[24]

D.W. Hosmer, S. Lemeshow.

Applied logistic regression.

Wiley-Interscience, (1989),

[25]

K.N. Haque.

Neonatal sepsis in very low birth weight preterm infants: part 2: review of definition, diagnosis and management.

Journal of Medical Sciences., 3 (2010), pp. 11-27

[26]

S.J. Cchrag, C.L. Cutland, E.R. Zell, L. Kuwanda, E.J. Buchmann, S.C. Velaphi, et al.

Risk factors for neonatal sepsis and perinatal death among infants enrolled in the prevention of perinatal sepsis trial, Soweto.

South Africa. Pediatr Infect Dis J., 31 (2012), pp. 821-826

[27]

D.P. Campos, M.V. Silva, J.R. Machado, L.R. Castellano, V. Rodrigues, C.H. Barata.

Early-onset neonatal sepsis: cord blood cytokine levels at diagnosis and during treatment.

J Pediatr (Rio J)., 86 (2010), pp. 509-514

[28]

R.M. Romanelli, L.M. Anchieta, M.V. Mourão, F.A. Campos, F.C. Loyola, P.H. Mourão, et al.

Fatores de risco e letalidade de infecção da corrente sanguínea laboratorialmente confirmada, causada por patógenos não contaminantes da pele em recém-nascidos.

J Pediatr (Rio J)., 89 (2013), pp. 189-196

[29]

H.C. Glass, S.L. Bonifacio, V. Chau, D. Glidden, K. Poskitt, A.J. Barkovich, et al.

Recurrent postnatal infections are associated with progressive white matter injury in preterm infants.

Pediatrics., 122 (2008), pp. 299-305

http://dx.doi.org/10.1542/peds.2007-2184 | Medline

[30]

M.A. Helmes, J. Nijman, A. Leemans, B.J. van Kooji, A. van den Hoo- gen, M.J. Benders, et al.

Cerebral white matter and neurode- velopment of preterm infants after coagulase-negative sta- phylococcal sepsis.

Pediatr Crit Care Med., 13 (2012), pp. 678-684

http://dx.doi.org/10.1097/PCC.0b013e3182455778 | Medline

[31]

I. Brandt, E.J. Sticker, M. Höcky, M.J. Lentze.

Transient abnormal neurologic signs (TANS) in a longitudinal study of very low birth weight preterm infants.

Early Hum Dev., 59 (2000), pp. 107-126

Medline

[32]

M.L. Gianní, O. Picciolini, M. Ravassi, L. Gardon, C. Vegni.

The effects of an early developmental mother-child intervention program on neurodevelopment outcome in very low birth weight infants: A pilot study.

Early Hum Dev., 82 (2006), pp. 691-695

http://dx.doi.org/10.1016/j.earlhumdev.2006.01.011 | Medline

☆

Como citar este artigo: Ferreira RC, Mello RR, Silva KS. Neonatal sepsis as a risk factor for neurodevelopmental changes in preterm infants with very low birth weight. J Pediatr (Rio J). 2014;90:293-9.

☆☆

Estudo realizado no Instituto Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Avenida Rui Barbosa 716, Flamengo, Rio de Janeiro, RJ, 22250-020, Brasil.

Indexed in:

Follow us:

Indexed in:

Follow us:

Subscribe to our newsletter