Socioemotional dysfunctions at age 10 years in extremely preterm newborns with late-onset bacteremia☆
Introduction
Children born extremely preterm (EP) are at a higher risk of social impairment than those born at term. These difficulties emerge early and persist throughout childhood [1]. Among EP children, the “preterm behavioral phenotype,” a constellation of disorders and symptoms characterized by anxiety, inattention, and social and communication, problems has been described [2]. Some of these mental health disorders might account for the lower parent-reported health-related quality of life among extremely preterm infants than in their peers born at term [3].
EP newborns are at increased risk of bacteremia [4], which increases the risk of abnormal brain structure [4]. Some of this increased risk might reflect the propensity of bacteremia to promote systemic inflammation [5], which is also associated with disturbed brain structure [[6], [7], [8]]. This, in turn, is associated with socio-emotional limitations [9]. We thus reasoned that very preterm newborns who experience bacteremia and its treatment might be at increased risk of social and related impairments.
The ELGAN study, with its relatively large extremely low gestational age cohort, detailed collection of information about bacteremia during the second through fourth postnatal weeks [5], and about socio-emotional and communication competence 10 years later [10], provided us with the opportunity to explore to what extent bacteremia might contribute to these social dysfunctions.
Section snippets
Participants
The ELGAN study is a multi-center prospective, observational study of the risk of structural and functional neurologic disorders in extremely preterm infants [11]. A total of 1506 infants born before the 28th week of gestation were enrolled from 2002 to 2004, and 1200 survived to 2 years. At age 2 years, 1102 had a developmental assessment [11]. For the current study, we targeted recruitment efforts at 966 of the 1102 children because we had collected neonatal blood specimens for assessment of
Results
The tables below can be read in two related ways. One approach is to compare children who had definite bacteremia to children who did not have bacteremia. The other is to see whether children who had suspected bacteremia are more similar to those who had confirmed bacteremia, or to those with no bacteremia at all.
Discussion
Our main finding is that ELGANs who had suspected bacteremia and those who had documented bacteremia during some of the first postnatal weeks were at increased risk for indicators of socioemotional and communication impairments 10 years later, independent of an autism diagnosis. Children who experienced documented bacteremia were at reduced risk for teacher-reported inattentive symptoms of ADHD, specific phobia, as well as motor and vocal tics.
Acknowledgements
The authors also gratefully acknowledge the contributions of their subjects, and their subjects’ families, as well as those of their colleagues listed below.
Boston Children's Hospital, Boston MA
Janice Ware, Taryn Coster, Brandi Henson, Rachel Wilson, Kirsten McGhee, Patricia Lee, Aimee Asgarian, Anjali Sadhwani
Tufts Medical Center, Boston MA
Ellen Perrin, Emily Neger, Kathryn Mattern, Jenifer Walkowiak, Susan Barron
University of Massachusetts Medical School, Worcester MA
Jean Frazier, Lauren
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Funding: This work was supported by: The National Institute of Neurological Disorders and Stroke [grant numbers 5U01NS040069-05, 2R01NS040069-06A2]; the National Eye Institute [grant number 1-R01- EY021820-01]; the National Institute of Child Health and Human Development [grant number 5P30HD018655-34]; and the Office of the National Institutes of Health Director [grant number 1UG3OD023348-01].
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The two first authors contributed equally.