Maternal or neonatal infection: association with neonatal encephalopathy outcomes

作者：Jenster Meike; Bonifacio Sonia L; Ruel Theodore; Rogers Elizabeth E; Tam Emily W; Partridge John Colin; Barkovich Anthony James; Ferriero Donna M; Glass Hannah C^*

来源：Pediatric Research, 2014, 76(1): 93-99.

DOI：10.1038/pr.2014.47

BACKGROUND: Perinatal infection may potentiate brain injury among children born preterm. The objective of this study was to examine whether maternal and/or neonatal infection are associated with adverse outcomes among term neonates with encephalopathy.
METHODS: This study is a cohort study of 258 term newborns with encephalopathy whose clinical records were examined for signs of maternal infection (chorioamnionitis) and infant infection (sepsis). Multivariate regression was used to assess associations between infection, pattern, and severity of injury on neonatal magnetic resonance imaging, as well as neuro-development at 30 mo (neuromotor examination, or Bayley Scales of Infant Development, second edition mental development index < 70 or Bayley Scales of Infant Development, third edition cognitive score < 85).
RESULTS: Chorioamnionitis was associated with lower risk of moderate-severe brain injury (adjusted odds ratio: 0.3; 95% confidence interval: 0.1-0.7; P = 0.004) and adverse cognitive outcome in children when compared with no chorioamnionitis. Children with signs of neonatal sepsis were more likely to exhibit watershed predominant injury than those without (P = 0.007).
CONCLUSION: Among neonates with encephalopathy, chorioamnionitis was associated with a lower risk of brain injury and adverse outcomes, whereas signs of neonatal sepsis carried an elevated risk. The etiology of encephalopathy and timing of infection and its associated inflammatory response may influence whether infection potentiates or mitigates injury in term newborns.

• 出版日期2014-7