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. 2023 Sep 1;42(9):739-744.
doi: 10.1097/INF.0000000000004006. Epub 2023 Jun 21.

Cumulative Febrile, Respiratory, and Gastrointestinal Illness Among Infants in Rural Guatemala and Association With Neurodevelopmental and Growth Outcomes

Daniel Olson  1   2   3   4 , Molly M Lamb  2   4 , Amy K Connery  3   5   6 , Alison M Colbert  3   5 , Diva M Calvimontes  7 , Desiree Bauer  7 , M Alejandra Paniagua-Avila  7 , María Alejandra Martínez  7 , Paola Arroyave  7 , Sara Hernandez  7 , Kathryn L Colborn  8 , Yannik Roell  2 , Jesse J Waggoner  9 , Muktha S Natrajan  9 , Evan J Anderson  9   10 , Guillermo A Bolaños  7 , Hana M El Sahly  11 , Flor M Munoz  12 , Edwin J Asturias  1   2   3   4
Affiliations

Cumulative Febrile, Respiratory, and Gastrointestinal Illness Among Infants in Rural Guatemala and Association With Neurodevelopmental and Growth Outcomes

Daniel Olson et al. Pediatr Infect Dis J. .

Abstract

Background: Infectious disease exposures in early life are increasingly recognized as a risk factor for poor subsequent growth and neurodevelopment. We aimed to evaluate the association between cumulative illness with neurodevelopment and growth outcomes in a birth cohort of Guatemalan infants.

Methods: From June 2017 to July 2018, infants 0-3 months of age living in a resource-limited region of rural southwest Guatemala were enrolled and underwent weekly at-home surveillance for caregiver-reported cough, fever, and vomiting/diarrhea. They also underwent anthropometric assessments and neurodevelopmental testing with the Mullen Scales of Early Learning (MSEL) at enrollment, 6 months, and 1 year.

Results: Of 499 enrolled infants, 430 (86.2%) completed all study procedures and were included in the analysis. At 12-15 months of age, 140 (32.6%) infants had stunting (length-for-age Z [LAZ] score < -2 SD) and 72 (16.7%) had microcephaly (occipital-frontal circumference [OFC] < -2 SD). In multivariable analysis, greater cumulative instances of reported cough illness (beta = -0.08/illness-week, P = 0.06) and febrile illness (beta = -0.36/illness-week, P < 0.001) were marginally or significantly associated with lower MSEL Early Learning Composite (ELC) Score at 12-15 months, respectively; there was no association with any illness (cough, fever, and/or vomiting/diarrhea; P = 0.27) or with cumulative instances of diarrheal/vomiting illness alone ( P = 0.66). No association was shown between cumulative instances of illness and stunting or microcephaly at 12-15 months.

Conclusions: These findings highlight the negative cumulative consequences of frequent febrile and respiratory illness on neurodevelopment during infancy. Future studies should explore pathogen-specific illnesses, host response associated with these syndromic illnesses, and their association with neurodevelopment.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

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