Maternal or neonatal infection: association with neonatal encephalopathy outcomes.
BACKGROUND
Perinatal infection may potentiate brain injury among children born preterm. The objective of this study was to examine whether maternal and/or neonatal infection are associated with adverse outcomes among term neonates with encephalopathy.


METHODS
This study is a cohort study of 258 term newborns with encephalopathy whose clinical records were examined for signs of maternal infection (chorioamnionitis) and infant infection (sepsis). Multivariate regression was used to assess associations between infection, pattern, and severity of injury on neonatal magnetic resonance imaging, as well as neurodevelopment at 30 mo (neuromotor examination, or Bayley Scales of Infant Development, second edition mental development index <70 or Bayley Scales of Infant Development, third edition cognitive score <85).


RESULTS
Chorioamnionitis was associated with lower risk of moderate-severe brain injury (adjusted odds ratio: 0.3; 95% confidence interval: 0.1-0.7; P = 0.004) and adverse cognitive outcome in children when compared with no chorioamnionitis. Children with signs of neonatal sepsis were more likely to exhibit watershed predominant injury than those without (P = 0.007).


CONCLUSIONS
Among neonates with encephalopathy, chorioamnionitis was associated with a lower risk of brain injury and adverse outcomes, whereas signs of neonatal sepsis carried an elevated risk. The etiology of encephalopathy and timing of infection and its associated inflammatory response may influence whether infection potentiates or mitigates injury in term newborns.
Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands.
Meike
M
Jenster
Department of Pediatrics, University of California, San Francisco, San Francisco, California.
Sonia L
SL
Bonifacio
Department of Pediatrics, University of California, San Francisco, San Francisco, California.
Theodore
T
Ruel
Department of Pediatrics, University of California, San Francisco, San Francisco, California.
Elizabeth E
EE
Rogers
Department of Neurology, University of California, San Francisco, San Francisco, California.
Emily W
EW
Tam
Department of Pediatrics, University of California, San Francisco, San Francisco, California.
John Colin
JC
Partridge
1] Department of Neurology, University of California, San Francisco, San Francisco, California [2] Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
Anthony James
AJ
Barkovich
1] Department of Pediatrics, University of California, San Francisco, San Francisco, California [2] Department of Neurology, University of California, San Francisco, San Francisco, California.
Donna M
DM
Ferriero
1] Department of Pediatrics, University of California, San Francisco, San Francisco, California [2] Department of Neurology, University of California, San Francisco, San Francisco, California.
Hannah C
HC
Glass
D001927:Brain Diseases / Q000209:etiology* / Q000628:therapy; D001930:Brain Injuries / Q000209:etiology* / Q000628:therapy; D002821:Chorioamnionitis / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation; D008279:Magnetic Resonance Imaging; D008297:Male; D018811:Maternal Exposure; D015999:Multivariate Analysis; D011247:Pregnancy; D018805:Sepsis / Q000628:therapy*; D016896:Treatment Outcome