Neonatal sepsis is associated with behavioral abnormalities in very low birthweight infants at preschool age

Abstract

ObjectiveThis study aimed to investigate neonatal sepsis as potential risk factor for adverse behavioral outcome in very low birth weight infants (VLBWI) at preschool age. Regardless of improvements in the obstetric and neonatal intensive care, preterm infants are still at high risk for behavioral problems later in life. The spectrum, origin and potential risk factors of these behavioral problems have not been well-defined.MethodsIn this retrospective observational study, the influence of culture-proven neonatal sepsis on the behavioral outcome of VLBWI born at a gestational age <32 weeks was analyzed at 5 years of age in a multivariable regression model. Behavior was assessed with the Child Behavior Checklist (CBCL). Neonatal morbidities, socioeconomic status and neurodevelopmental outcome served as covariates in the analysis.Results312 VLBWI entered the final analysis, of whom 11% had experienced neonatal sepsis. Neonatal sepsis appeared to be a relevant risk factor for both internalizing, i.e., emotional reactivity and anxiety/depression, as well as externalizing behavioral problems, i.e., oppositional and aggressive behavior in this cohort of VLBWI. Low socioeconomic status and male gender were additional statistically significant risk factors for both internalizing and externalizing behavioral problems. No difference in neurocognitive development was observed between the groups.ConclusionThe study supports the fact that VLBWI are vulnerable to multiple behavioral disorders independent of their cognitive development. In contrast to former assumptions, the results of the study emphasize that not only post-natal environment but also neonatal morbidities, especially neonatal sepsis, have an impact on behavioral outcome of VLBWI at preschool age.

Behavioral outcome of very preterm children at 5 years of age: Prognostic utility of brain tissue volumes at term‐equivalent‐age, perinatal, and environmental factors

“…Risk factors such as sepsis have been associated with adverse outcomes in preterm children (Lee et al., 2014 ), as well as a higher incidence of hyperactivity symptoms at preschool age (Kavas et al., 2017 ). In a study investigating behavioral abnormalities (measured by the Child Behavior Checklist) at 5 years of age in children born VPT in relation to neonatal morbidities, neonatal sepsis appeared to be a relevant risk factor for both internalizing and externalizing behavioral problems (Giordano et al., 2022 ). This is in‐line with our results, as the post hoc analysis showed a tendency for more hyperactivity at age 5 years in subjects who experienced neonatal sepsis.…”

Assessing Behavioral Disorders with SDQ in Very Preterm Children at 5 Years of Age in LIFT Cohort

“…Factors stemming from the babies were strongly associated with behavioral difficulties, but their medical explanations are still under discussion. For instance, recently, Giordano et al found, in VLBW at the preschool age, an impact on the behavioral outcomes of neonatal morbidities, especially neonatal sepsis [23], whereas a recent review in 2016 did not emphasize specific perinatal risk factors, but found that behavioral outcome measures were heterogeneous [8].…”

May Pentoxifylline Protect Immature Brain Against Disorders Induced By Inflammatory Response In Neonatal Sepsis?

“…Moreover, it was found that inflammatory response due to sepsis may impair the process of myelinization and in turn either disrupts the white matter tissue development, or inhibits brain growth, which increases the risk of attentional performance in preterm infants [4]. Recently, Giordano and coauthors [5] suggested that neonatal sepsis might be a risk factor for behavioral abnormalities observed at the age of 5 years in former very low birth weight infants. These infants displayed a more frequently elevated risk for depression, anxiety, and higher than normal emotional reactivity, as well as attention deficits.…”