Early Life Parechovirus Infection Neurodevelopmental Outcomes at 3 Years: A Cohort Study

Philip N Britton; Karen Walker; Brendan McMullan; Claire Galea; Rebecca Burrell; Bronte Morgan; Ingrid Honan; Suzy Teutsch; Hayley Smithers-Sheedy; Natalie Fairbairn; Richard Mattick; Delyse Hutchinson; Cheryl A Jones

doi:10.1016/j.jpeds.2019.12.026

Early Life Parechovirus Infection Neurodevelopmental Outcomes at 3 Years: A Cohort Study

J Pediatr. 2020 Apr:219:111-117.e1. doi: 10.1016/j.jpeds.2019.12.026. Epub 2020 Jan 28.

Authors

Affiliations

¹ Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia. Electronic address: philip.britton@health.nsw.gov.au.
² Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia; The George Institute for Global Health, Sydney, Australia.
³ Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney Children's Hospitals Network, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
⁴ Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia.
⁵ Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁶ Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia.
⁷ Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia.
⁸ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
⁹ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia.
¹⁰ Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia.

PMID: 32005541
DOI: 10.1016/j.jpeds.2019.12.026

Abstract

Objective: To investigate the long-term developmental and behavioral outcomes in an established cohort of children hospitalized as infants with human parechovirus (HPeV) infection and sepsis-like illness.

Study design: The HPeV cohort was composed of children 3 years of age after HPeV infection and hospitalization in early infancy that occurred during a well-documented HPeV genotype 3 outbreak in Australia. We assessed neurodevelopmental and behavioral outcomes using the Bayley Scales of Infant and Toddler Development-III and the Child Behavior Checklist. We compared their outcomes with a subsample of healthy control infants drawn from the independently sampled Triple B Pregnancy Cohort Study.

Results: Fifty children, with a mean age of 41 months, were followed for 3 years after hospital admission with HPeV infection. There were 47 children whose original illness was fever without source or sepsis-like illness and 3 who had encephalitis. All children in the HPeV cohort showed age-specific development within the population normal range on the Bayley Scales of Infant and Toddler Development-III. There was no difference in developmental attainment compared with 107 healthy control infants after adjusting for measured confounders. The HPeV cohort showed higher average scores on the Child Behavior Checklist and a higher frequency of clinical range scores compared with healthy controls.

Conclusions: Although HPeV sepsis-like illness did not result in neurodevelopmental delay at 3 years of age, it was associated with increased behavioral problems compared with healthy controls. The behavioral problems reached a clinical threshold in a minority of children. Results inform clinical management and planning for children after severe HPeV infection in infancy.

Keywords: Parechovirus; child; development; infant; neurology; newborn.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child, Preschool
Cohort Studies
Female
Follow-Up Studies
Humans
Male
Neurodevelopmental Disorders / virology*
Parechovirus*
Picornaviridae Infections / complications*
Time Factors