title: The impact of prenatal and neonatal infection on neurodevelopmental outcomes in very preterm infants.
abstract: OBJECTIVE
  Determine the association of prenatal and neonatal infections with neurodevelopmental outcomes in very preterm infants.
  
  
  METHODS
  Secondary retrospective analysis of 155 very preterm infants at a single tertiary referral center. General linear or logistic regression models were used to evaluate the association with hospital factors; brain injury, growth and development; and neurobehavioral outcome.
  
  
  RESULTS
  Necrotizing enterocolitis with sepsis was associated with reduced transcerebellar diameter (38.3 vs 48.4 mm, P<0.001) and increased left ventricular diameter (12.0 vs 8.0 mm, P=0.005). Sepsis alone was associated with higher diffusivity in the left frontal lobe (1.85 vs 1.68 × 10⁻³ mm² s⁻¹, P=0.001) and right cingulum bundle (1.52 vs 1.45 × 10⁻³ mm 253 s⁻¹, P=0.002). Neurobehavioral outcomes were worse in children exposed to maternal genitourinary infection (cognitive composite: β=-8.8, P=0.001; receptive language score: β=-2.7, P<0.001; language composite: β=-14.9, P<0.001) or histological chorioamnionitis (language composite: β=-8.6, P=0.006), but not neonatal infection.
  
  
  CONCLUSIONS
  Neonatal infection was associated with changes in brain structure but not with neurobehavioral outcomes, whereas the opposite pattern was observed for maternal genitourinary tract infection. These findings emphasize the potential importance of infections during pregnancy on the neurodevelopmental outcomes of preterm infants.
authors.affiliation: Department of Pediatrics, Washington University, St Louis, MO, USA.
authors.forename: I
authors.initials: I
authors.lastname: Lee
authors.affiliation: 1] Department of Pediatrics, Washington University, St Louis, MO, USA [2] Department of Neurology, Washington University, St Louis, MO, USA [3] Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Neil
authors.affiliation: Department of Pathology and Immunology, Washington University, St Louis, MO, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Huettner
authors.affiliation: 1] Department of Pediatrics, Washington University, St Louis, MO, USA [2] Department of Neurology, Washington University, St Louis, MO, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Smyser
authors.affiliation: Department of Psychiatry, Washington University, St Louis, MO, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Rogers
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Shimony
authors.affiliation: Department of Pediatrics, Washington University, St Louis, MO, USA.
authors.forename: H
authors.initials: H
authors.lastname: Kidokoro
authors.affiliation: Department of Obstetrics and Gynecology, Washington University, St Louis, MO, USA.
authors.forename: I U
authors.initials: IU
authors.lastname: Mysorekar
authors.affiliation: 1] Department of Pediatrics, Washington University, St Louis, MO, USA [2] Department of Neurology, Washington University, St Louis, MO, USA [3] Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA.
authors.forename: T E
authors.initials: TE
authors.lastname: Inder
mesh_terms: D016470:Bacteremia / Q000150:complications* / Q000175:diagnosis; D001927:Brain Diseases / Q000209:etiology* / Q000503:physiopathology; D002653:Child Behavior Disorders / Q000209:etiology / Q000503:physiopathology; D002821:Chorioamnionitis / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D062071:Infant, Extremely Premature / Q000254:growth & development*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology; D019102:Infant, Very Low Birth Weight / Q000254:growth & development; D016014:Linear Models; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009483:Neuropsychological Tests; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis