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

摘要

Objective To establish the influence of late‐onset sepsis on neurodevelopment of preterm infants with very low birth weight (VLBW), according to the etiologic agent. Method This was a cohort of newborns with birth weight < 1,500g and gestational age less than 32 weeks, admitted to the institutional intensive care unit (ICU) with up to 48hours of life, and followed‐up at the outpatient follow‐up clinic for preterm infants with VLBW until 2 years of corrected age. Exclusion criteria: death within the first 72hours of life, congenital malformations and genetic syndromes, children with congenital infection by the human immunodeficiency virus (HIV), congenital infection (STORCH), presence of early‐onset spesis and cases with more than one pathogen growth in blood cultures. Septic and non‐septic infants were compared regarding neonatal outcomes and mortality. Neurodevelopment was assessed using the Bayley Scale (BSDI‐II) at 18 to 24 months of corrected age. Results 411 preterm infants with VLBW were eligible; the mean gestational age was 29 ± 2.2 weeks and mean birth weight was 1,041 ± 281grams. Late‐onset sepsis occurred in 94 preterm infants with VLBW (22.8%). VLBW infants with Gram‐positive infection showed motor deficit when compared to the non‐septic group, 68.8% vs. 29.3%, respectively (OR 6; 1.6‐21.8, p = 0.006); the cognitive development was similar between the groups. The overall mortality rate from infection was 26.7%; considering the pathogens, the rates were 18.7% for coagulase‐negative Staphylococcus, 21.8% for Gram‐positive bacteria, and 50% for Gram‐negative bacteria and fungi. Conclusion Neonatal sepsis has a significant influence on late neurodevelopment at 2 years of corrected age in preterm infants with VLBW, and Gram‐positive infections are associated with motor deficit.