Neurodevelopmental outcome at 2 years of age in preterm infants with late-onset sepsis

Zonnenberg, Inge A.; Dijk-Lokkart, Elisabeth M. van; Dungen, Frank A. M. van den; Vermeulen, R. Jeroen; Weissenbruch, Mirjam M. van

doi:10.1007/s00431-019-03339-2

Cited by 28 publications

(36 citation statements)

References 21 publications

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“…The details of the study design and study population are summarised in Table 1. Eight studies were multicentre cohort studies [43][44][45][46][47][48][49][50], 12 were single-centre cohort studies [51][52][53][54][55][56][57][58][59][60][61][62] and four were single-centre case-control studies [63][64][65][66]. All studies were retrospective in design.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All studies were retrospective in design. Ten studies used retrospectively collected data [51][52][53]56,59,60,[63][64][65] and 13 studies used prospectively collected data [44][45][46][47][48][49][50]55,57,58,61,62,66]. Publications years were between 1994 and 2019.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Overall, the median attrition rate of all studies was 20% (range 3%-45%). Fourteen studies specifically analysed the impact of sepsis [45][46][47]49,52,55,57,58,[62][63][64][65][66], whereas the other ten studied perinatal variables more generally with sepsis as a factor [44,48,50,51,53,56,[59][60][61]. Fourteen studies did not report the prevalence of each micro-organism [44,[47][48][49][50][51][53][54][55][56][59][60][61]66].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Fourteen studies did not report the prevalence of each micro-organism [44,[47][48][49][50][51][53][54][55][56][59][60][61]66]. Seven analysed the prevalence of each microorganism [43,45,46,58,62,64,65], of which four included fungal infections [43,46,58,65]. Two studies restricted their studies to Candidaemia only [52,63] and one restricted to coagulase-negative Staphylocci sepsis only [57].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Four studies had a follow-up duration of more than or equal to 36 months [47,51,59,60]. Five studies had blinded outcome assessors [49,51,57,58,62], one reported no blinding was performed [54] and the rest did not specify [43][44][45][46]48,50,52,53,55,56,[59][60][61][63][64][65][66]. Age of assessment ranged from 18 months to 15 years.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Short- and Long-Term Neurodevelopmental Outcomes of Very Preterm Infants with Neonatal Sepsis: A Systematic Review and Meta-Analysis

et al. 2019

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Sepsis is commonly experienced by infants born very preterm (<32 weeks gestational age and/or <1500 g birthweight), but the long-term functional outcomes are unclear. The objective of this systematic review was to identify observational studies comparing neurodevelopmental outcomes in very preterm infants who had blood culture-proven neonatal sepsis with those without sepsis. Twenty-four studies were identified, of which 19 used prespecified definitions of neurodevelopmental impairment and five reported neurodevelopmental outcomes as continuous variables. Meta-analysis was conducted using 14 studies with defined neurodevelopmental impairment and demonstrated that very preterm infants with neonatal sepsis were at higher risk of impairments, such as cerebral palsy and neurosensory deficits, compared with infants without sepsis (OR 3.18; 95% CI 2.29-4.41). Substantial heterogeneity existed across the studies (I 2 = 83.1, 95% CI 73-89). The five studies that reported outcomes as continuous variables showed no significant difference in cognitive performance between sepsis and non-sepsis groups. Neonatal sepsis in very preterm infants is associated with increased risk of neurodevelopmental disability. Due to the paucity of longitudinal follow-up data beyond 36 months, the long-term cognitive effect of neonatal sepsis in very preterm infants could not be conclusively determined. Effects on the development of minor impairment could not be assessed, due to the small numbers of infants included in the studies.Children 2019, 6, 131 2 of 25 proportional to gestational age, with 33% of infants born less than 28 weeks acquiring sepsis compared with 60% of infants born less than 25 weeks [5].During the neonatal period, complications such as sepsis can have dramatic effects on the growth and development of the child, especially in children born very prematurely [6,7]. The mechanism of how sepsis inflicts brain damage has been hypothesised. Research suggests the developing brain is vulnerable to the systematic inflammatory milieu characteristic of sepsis, as well as cytotoxic and ischaemic injury from hypotension and reduced cerebral blood flow [7]. Together, these factors may result in white matter abnormalities and diffuse injury to premyelinating oligodendrocytes, which have been shown to be closely associated with increased risk for impaired cognitive and motor functioning [8,9]. Such morbidities are complex and can range from major impairments, such as cerebral palsy, to more subtle deficits such as difficulties with memory and attention. Regardless, they all have the potential to affect a child's academic, social and emotional functioning. Neurodevelopmental follow-up in VP infants with sepsis is crucial for the early identification of developmental delay so that targeted interventions can be prescribed to minimise long-lasting impairments.The short-term cognitive impact of sepsis in VP infants has been studied. A systematic review of 17 studies on VLBW infants with neonatal sepsis concluded these infants are at twice the r...

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Short- and Long-Term Neurodevelopmental Outcomes of Very Preterm Infants with Neonatal Sepsis: A Systematic Review and Meta-Analysis

et al. 2019

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Brain age predicted using graph convolutional neural network explains neurodevelopmental trajectory in preterm neonates

Liu,

Lu,

Kim

et al. 2023

Eur Radiol

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Objectives Dramatic brain morphological changes occur throughout the third trimester of gestation. In this study, we investigated whether the predicted brain age (PBA) derived from graph convolutional network (GCN) that accounts for cortical morphometrics in third trimester is associated with postnatal abnormalities and neurodevelopmental outcome. Methods In total, 577 T1 MRI scans of preterm neonates from two different datasets were analyzed; the NEOCIVET pipeline generated cortical surfaces and morphological features, which were then fed to the GCN to predict brain age. The brain age index (BAI; PBA minus chronological age) was used to determine the relationships among preterm birth (i.e., birthweight and birth age), perinatal brain injuries, postnatal events/clinical conditions, BAI at postnatal scan, and neurodevelopmental scores at 30 months. Results Brain morphology and GCN-based age prediction of preterm neonates without brain lesions (mean absolute error [MAE]: 0.96 weeks) outperformed conventional machine learning methods using no topological information. Structural equation models (SEM) showed that BAI mediated the influence of preterm birth and postnatal clinical factors, but not perinatal brain injuries, on neurodevelopmental outcome at 30 months of age. Conclusions Brain morphology may be clinically meaningful in measuring brain age, as it relates to postnatal factors, and predicting neurodevelopmental outcome. Clinical relevance statement Understanding the neurodevelopmental trajectory of preterm neonates through the prediction of brain age using a graph convolutional neural network may allow for earlier detection of potential developmental abnormalities and improved interventions, consequently enhancing the prognosis and quality of life in this vulnerable population. Key Points •Brain age in preterm neonates predicted using a graph convolutional network with brain morphological changes mediates the pre-scan risk factors and post-scan neurodevelopmental outcomes. •Predicted brain age oriented from conventional deep learning approaches, which indicates the neurodevelopmental status in neonates, shows a lack of sensitivity to perinatal risk factors and predicting neurodevelopmental outcomes. •The new brain age index based on brain morphology and graph convolutional network enhances the accuracy and clinical interpretation of predicted brain age for neonates.

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Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein may reduce central line–associated bloodstream infection in preterm infants

et al. 2020

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The objective of this study was to assess the risk of central line-associated bloodstream infection (CLABSI) of ultrasound (US)guided cannulation of the brachiocephalic vein (BCV) compared to standard epicutaneous cava catheters (ECCs) in preterm infants. This was a retrospective cohort study in preterm infants with a birth weight of less than 1500 g. Each BCV catheter was matched 1:3 with ECCs according to sex, birth weight, and year of insertion. The main outcome was the CLABSI density rate per 1000 days. Secondary outcomes included CLABSI episodes, CLABSI episodes per infant, and CLABSI/death. A multivariate Cox regression analysis was performed to assess whether the type of catheter (ECC vs. BCV) was associated with CLABSI risk. Ninety-six catheters (21 BCVs and 75 ECCs) in 79 infants were included (993 catheter days). BCV catheters were associated with a reduced CLABSI density rate compared to ECCs (3.05/1000 days vs 21.1/1000 days; p < 0.001). ECCs were associated with increased CLABSI risk compared to BCV catheters in multivariate analysis (hazard ratio 36; (95% CI, 2.5-511); p = 0.008).Conclusion: US-guided supraclavicular cannulation of the BCV was associated with a reduced risk of CLABSI compared to ECCs. This finding deserves further multicenter research. What is Known:• An epicutaneous-cava catheter (ECC) is commonly used in preterm infants for routine care (eg. delivery of nutrition and antibiotics) but this device may not suffice in infants who need high-intensity care (multiple drugs, hemodynamic monitoring, fluid resuscitation etc.). • Ultrasound-guided brachiocephalic vein (BCV) catheterization has shown a high success rate and few immediate complications in neonates and small infants but it has never been compared to standard ECCs. What is New: • When the operator in properly trained, US guided cannulation of the BCV in preterm infants is feasible, safe and may reduce the risk of CLABSI compared to standard ECCs. • This fact may expand the use of BCV catheters in selected high-risk preterm infants who need a large bore venous access.

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Neurodevelopmental outcome at 2 years of age in preterm infants with late-onset sepsis

Cited by 28 publications

References 21 publications

Short- and Long-Term Neurodevelopmental Outcomes of Very Preterm Infants with Neonatal Sepsis: A Systematic Review and Meta-Analysis

Short- and Long-Term Neurodevelopmental Outcomes of Very Preterm Infants with Neonatal Sepsis: A Systematic Review and Meta-Analysis

Brain age predicted using graph convolutional neural network explains neurodevelopmental trajectory in preterm neonates

Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein may reduce central line–associated bloodstream infection in preterm infants

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