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Review
. 2019 Dec 1;6(12):131.
doi: 10.3390/children6120131.

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

Shirley Cai  1   2   3 , Deanne K Thompson  1   2   4   5 , Peter J Anderson  1   6 , Joseph Yuan-Mou Yang  2   4   7   8
Affiliations
Review

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

Shirley Cai et al. Children (Basel). .

Abstract

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 (I2 = 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.

Keywords: brain; cognition; development; infant; infection; premature.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of the study selection process.
Figure 2
Figure 2
Assessment of risk of bias of the 24 included studies. The risk of bias was assessed using a modified version of the Cochrane Collaboration’s tool for assessing risk of bias; see Table S2.
Figure 3
Figure 3
Forest plot showing the results of random effects meta-analysis of the 14 studies comparing neurodevelopmental outcomes in very premature infants with and without neonatal sepsis exposure (Outcome: number of participants with neurodevelopmental impairment). NDI—neurodevelopmental impairment; OR—odds ratio; CI—confidence interval.
Figure 4
Figure 4
Contour-enhanced funnel plot of the 14 studies with reported dichotomised neurodevelopmental outcomes.
Figure 5
Figure 5
Forest plot of the subanalysis of studies which had a follow-up duration of 36 months or greater. The plot shows the results of random effects meta-analysis of the four studies comparing neurodevelopmental outcomes in very premature infants with and without neonatal sepsis exposure (Outcome: number of participants with neurodevelopmental impairment).
See this image and copyright information in PMC

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