Late-Onset Sepsis in Preterm Neonates is Associated with Higher Risks of Cerebellar Hemorrhage and Lower Motor Scores at 3 Years of Age

Abstract

Background: Sepsis is associated with adverse neonatal outcomes, including diffuse white matter injury (WMI) which may predispose to developmental delay. Objective: To evaluate the impact of late-onset sepsis (LOS) in preterm infants on brain injury and neurodevelopmental outcomes at 36 months corrected age (CA). Design: Retrospective cohort study. Setting: Neonatal Sepsis Registry at Neonatal Department, Al-Sabah Maternity hospital, Kuwait. Participants: A total of 203 neonates (gestational age (GA) between 24-32 weeks) were admitted between January 2017 and December 2017. Neonates were stratified into no sepsis, into early-onset sepsis (first onset of sepsis ≤72 hours postnatally), and LOS (>72 hours postnatally) 2 Main outcome: Brain injury and neurodevelopmental outcomes at 36 months CA were evaluated using Miller score and Bayley-III scales of infant development, respectively. Results: Sixteen neonates had early-onset sepsis with Klebsiella pneumonia and group-B streptococcus, and 93 developed LOS with K. pneumonia and gram-positive cocci in clusters. Intraventricular hemorrhage (n=68) and WMI (n=42) showed no group-wise differences. Higher cerebellar hemorrhage risk (adjusted odds ratio=4.6 (1.3-18.6); p=0.03) and lower motor composite scores (adjusted β=-9.5 (-16.4 to -2.7); p=0.007) were observed with LOS. Conclusions: LOS in preterm neonates is a significant risk factor predisposing to cerebellar hemorrhage and lower motor scores by three years of age.