Late-onset Sepsis in Preterm Neonates is Associated with Higher Risks of Cerebellar Hemorrhage and Lower Motor Scores at Three Years of Age

Abstract

Objectives: To evaluate the impact of late-onset sepsis (LOS) in preterm infants on brain injury and neurodevelopmental outcomes at 36 months corrected age (CA).

Methods: We retrospectively analyzed the medical records of 203 preterm neonates of 24-32 weeks gestational age who were admitted between January and December 2017 at the neonatal intensive care unit (NICU) of a maternity hospital in Kuwait. The cases were stratified into no sepsis, early-onset sepsis (first onset of sepsis ≤ 72 hours postnatally), and LOS (> 72 hours postnatally). Brain injury was assessed from MRI records. Neurodevelopmental outcomes were evaluated at 36 months CA using Bayley-III scales of infant development.

Results: Out of 203 neonates, 16 had early-onset sepsis with Klebsiella pneumonia and group B streptococcus, and 93 developed LOS with K. pneumonia and gram-positive cocci in clusters. There were no group-wise differences in the prevalence of intraventricular hemorrhage (n = 68) or white matter injury (n = 42). However, higher cerebellar hemorrhage risk (adjusted odds ratio = 4.6 (1.3-18.6; p = 0.030) was observed in LOS group. At 36 months CA, infants in the LOS group were more likely to have lower motor, cognitive, and language composite scores. After adjusting for gestational age, birth weight, cerebellar hemorrhage, and white matter injury, the relationship between LOS and lower motor scores remained significant (adjusted β = -9.5, 95% CI: -16.4 to -2.7; p = 0.007), whereas the association with cognitive and language scores were no longer significant.

Conclusions: LOS in preterm neonates significantly raises the risk of cerebellar hemorrhage and lower motor scores by three years of age.

Keywords: Brain Injuries; Hemorrhage; Infant, Newborn; Infections; Sepsis.

Figure 1

Comparison of Bayley-III developmental outcomes at 36 months corrected age, of no neonatal sepsis, early-onset sepsis, and late-onset sepsis. (a) Motor outcome, (b) cognitive outcome, and (c) language outcome. The vertical line reflects the median and the box indicates the interquartile range. The outliers are indicated by the little black circles.