Perinatal infections and neurodevelopmental outcome in very preterm and very low-birth-weight infants: a meta-analysis

JAMA Pediatr. 2013 Jul;167(7):662-8. doi: 10.1001/jamapediatrics.2013.1199.

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.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Bacterial Infections / epidemiology*
  • Humans
  • Infant, Extremely Premature
  • Infant, Newborn
  • Infant, Premature, Diseases / epidemiology*
  • Infant, Very Low Birth Weight
  • Nervous System Diseases / epidemiology*
  • Perinatal Care