Neonatal sepsis and simple minor neurological dysfunction

Nazan Kavas, Ayşe Engin Arısoy, Asuman Bayhan, Bülent Kara, Ayla Günlemez, Gülcan Türker, Meral Oruç, Ayşe Sevim Gökalp
2017 Pediatrics International  
This study examined potential risk factors for and consequences of simple minor neurological dysfunction (SMND), in a group of very low birth weight newborns followed until preschool age. Methods: This is a prospective longitudinal study. Children with a birth weight below 1,500 g were assessed at 4 to 6 years of age. Twenty eight children with a normal neurological examination and 35 children with simple minor neurological dysfunction were included in the final analysis. Risk factors for the
more » ... velopment of SMND and its association with certain neuropsychiatric conditions were studied. Results: Based on neonatal data, Apgar scores at 1 minute (6.13±2.37 vs. 7.66±1.04, p=0.008) and at 5 minutes (8.63±1.29 vs. 9.45±0.65, p=0.019) were lower, the duration of hospital stay (45.8±21.8 vs. 35.1±18.2 days, p=0.037) was longer, and the frequency of sepsis (73.5% vs. 25%, p<0.001) was higher in children with SMND. Sepsis was found to be an independent risk factor for SMND (OR, 7.6 [95% CI: 2.2-26.0], p=0.001). The children with SMND were found to have lower IQs and higher prevalence of hyperactivity and refraction error. Conclusion: Postnatal sepsis emerged as the single most important risk factor for the development of SMND and these children with SMND are at great risk for certain neuropsychiatric conditions. Preventive strategies, particularly for sepsis at the newborn period, and early diagnosis and rehabilitation of future neuropsychiatric disorders are needed for better management of these cases. Accepted Article This article is protected by copyright. All rights reserved. Keywords: neuropsychiatric problems, sepsis, simple minor neurological dysfunction, very low birth weight The development of the nervous system starts during the prenatal period and the most dramatic changes occur during prenatal life and the first postnatal years. Many changes take place even after two years of age and this developmental process continues well into the adolescence. 1,2 Studies in the field of neurodevelopmental medicine have pointed out to the presence of a milder form of neurological disorder that is referred to as the "minor neurological dysfunction" (MND), which is thought to stem from minor aberrations of the brain function undetectable by the conventional neurological examination methods. MND usually does not result in diffuse involvement of the nervous system, but rather tends to affect functional systems without being accompanied by significant motor or cognitive dysfunction. Subjects with MND have mild dysregulation of the muscle tone and experience difficulties in fine-gross motor coordination, leading to motor clumsiness. MND is generally categorized into "simple" and "complex" types. Special examination techniques are required to assess the functional systems of the brain in high-risk groups for MND. An adverse event occurring at any stage of the slow process of neurological development may result in a variety of clinical manifestations of MND at different time-points of life. 3, 4 Advances in the care of premature newborns have led to an increased survival rate in premature infants, particularly in those with a birth weight between 1,000 and 1,499 g, with an associated decrease in the incidence of cerebral palsy (CP). 5 However, despite limited data, preliminary evidence suggests that premature newborns are at an increased risk of MND in comparison with age-matched term newborns. 6,7 An increased incidence of a variety
doi:10.1111/ped.13217 pmid:27935218 fatcat:wds4uarvqrgnhbbia2t262bq54