Adverse neurodevelopment in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term.
OBJECTIVE
To test the hypothesis that the impact of postnatal sepsis/necrotizing enterocolitis (NEC) on neurodevelopment may be mediated by white matter abnormality (WMA), which can be demonstrated with magnetic resonance imaging (MRI).


METHODS
A prospective cohort of 192 unselected preterm infants (gestational age <30 weeks), who were evaluated for sepsis and NEC, underwent imaging at term-equivalent age and neurodevelopmental outcome at 2 years corrected age with the Bayley Scales of Infant Development.


RESULTS
Sixty-eight preterm (35%) infants had 100 episodes of confirmed sepsis, and 9 (5%) infants had confirmed NEC. Coagulase-negative staphylococci accounted for 73% (73/100) of the episodes of confirmed sepsis. Infants with sepsis/NEC had significantly more WMA on MRI at term compared with infants in the no-sepsis/NEC group. They also had poorer psychomotor development that persisted after adjusting for potential confounders but which became nonsignificant after adjusting for WMA.


CONCLUSIONS
Preterm infants with sepsis/NEC are at greater risk of motor impairment at 2 years, which appears to be mediated by WMA. These findings may assist in defining a neuroprotective target in preterm infants with sepsis/NEC.
Shah
Divyen K
DK
Department of Pediatrics, Washington University, St Louis, MO 63105, USA. shah_d@kids.wustl.edu
Doyle
Lex W
LW
Anderson
Peter J
PJ
Bear
Merilyn
M
Daley
Andrew J
AJ
Hunt
Rod W
RW
Inder
Terrie E
TE
D015984:Causality; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology*; D019102:Infant, Very Low Birth Weight; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology*; D012720:Severity of Illness Index