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. 2008 Aug;153(2):170-5, 175.e1. doi: 10.1016/j.jpeds.2008.02.033. Epub 2008 Apr 3.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Causality
  • Child, Preschool
  • Cohort Studies
  • Comorbidity
  • Developmental Disabilities / diagnosis
  • Developmental Disabilities / epidemiology*
  • Enterocolitis, Necrotizing / epidemiology*
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature, Diseases / diagnosis
  • Infant, Premature, Diseases / epidemiology*
  • Infant, Very Low Birth Weight
  • Magnetic Resonance Imaging
  • Male
  • Neuropsychological Tests / statistics & numerical data
  • Prospective Studies
  • Sepsis / epidemiology*
  • Severity of Illness Index