title: Association of late-onset neonatal sepsis with late neurodevelopment in the first two years of life of preterm infants with very low birth weight.
abstract: 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.
  
  
  METHODS
  This was a cohort of newborns with birth weight<1,500 g and gestational age less than 32 weeks, admitted to the institutional intensive care unit (ICU) with up to 48 hours of life, and followed-up at the outpatient follow-up clinic for preterm infants with VLBW until 2 years of corrected age.
  
  
  METHODS
  death within the first 72 hours of life, congenital malformations and genetic syndromes, children with congenital infection by the human immunodeficiency virus (HIV), congenital infection (STORCH), presence of early-onset sepsis 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 ± 281 grams. 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clinícas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Cláudia Regina
authors.initials: CR
authors.lastname: Hentges
authors.affiliation: Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clinícas de Porto Alegre, Porto Alegre, RS, Brazil. Electronic address: drarita.c.s@gmail.com.
authors.forename: Rita C
authors.initials: RC
authors.lastname: Silveira
authors.affiliation: Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clinícas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Renato Soibelmann
authors.initials: RS
authors.lastname: Procianoy
authors.affiliation: Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clinícas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Clarissa Gutierrez
authors.initials: CG
authors.lastname: Carvalho
authors.affiliation: Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Gabriela Ribeiro
authors.initials: GR
authors.lastname: Filipouski
authors.affiliation: Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Rubia Nascimento
authors.initials: RN
authors.lastname: Fuentefria
authors.affiliation: Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Marquezotti
authors.affiliation: Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Ana Carolina
authors.initials: AC
authors.lastname: Terrazan
mesh_terms: D015331:Cohort Studies; D002658:Developmental Disabilities / Q000382:microbiology*; D005260:Female; D005865:Gestational Age; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D019957:Motor Skills Disorders / Q000382:microbiology*; D015999:Multivariate Analysis; D011446:Prospective Studies; D018805:Sepsis / Q000382:microbiology* / Q000401:mortality
keywords: Mortalidade; Mortality; Muito baixo peso ao nascer; Neonatal sepsis; Neurodesenvolvimento; Neurodevelopment; Prematuros; Preterm; Sepse neonatal; Very low birth weight