Neonatal infection and 5-year neurodevelopmental outcome of very preterm infants

Pediatrics. 2013 Aug;132(2):e372-80. doi: 10.1542/peds.2012-3979. Epub 2013 Jul 22.


Objective: To determine whether neonatal infections are associated with a higher risk of adverse neurodevelopment at 5 years of age in a population-based cohort of very preterm children.

Methods: We included all live births between 22 and 32 weeks of gestation, from 9 regions in France, in 1997 (EPIPAGE study). Of the 2665 live births, 2277 were eligible for a follow-up evaluation at 5 years of age: 1769 had a medical examination and 1495 underwent cognitive assessment. Cerebral palsy and cognitive impairment were studied as a function of early-onset sepsis (EOS) and late-onset sepsis (LOS), after adjustment for potential confounding factors, in multivariate logistic regression models.

Results: A total of 139 (5%) of the 2665 live births included in the study presented with EOS alone (without associated LOS), 752 (28%) had LOS alone (without associated EOS), and 64 (2%) displayed both EOS and LOS. At 5 years of age, the frequency of cerebral palsy was 9% (157 of 1769) and that of cognitive impairment was 12% (177 of 1495). The frequency of cerebral palsy was higher in infants with isolated EOS (odds ratio [OR]: 1.70 [95% confidence interval (CI): 0.84-3.45]) or isolated LOS (OR: 1.71 [95% CI: 1.14-2.56]) than in uninfected infants, and this risk was even higher in cases of combined EOS and LOS (OR: 2.33 [95% CI: 1.02-5.33]). There was no association between neonatal infection and cognitive impairment.

Conclusions: Neonatal infections in these very preterm infants were associated with a higher risk of cerebral palsy at the age of 5 years, particularly in infants presenting with both EOS and LOS.

Keywords: cohort study; neonatal infection; neurodevelopmental outcome; population-based study; very preterm infants.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cerebral Palsy / diagnosis
  • Cerebral Palsy / epidemiology
  • Child, Preschool
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology
  • Cohort Studies
  • Cross Infection / diagnosis*
  • Cross Infection / epidemiology*
  • Cross Infection / transmission
  • Cross-Sectional Studies
  • Developmental Disabilities / diagnosis*
  • Developmental Disabilities / epidemiology*
  • Female
  • France
  • Gestational Age
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature, Diseases / diagnosis*
  • Infant, Premature, Diseases / epidemiology*
  • Infant, Very Low Birth Weight*
  • Infectious Disease Transmission, Vertical
  • Longitudinal Studies
  • Male
  • Neuropsychological Tests
  • Risk Factors
  • Sepsis / diagnosis*
  • Sepsis / epidemiology*
  • Sepsis / transmission