Is infection a factor in neonatal encephalopathy?

Nelson, Karin B.; Penn, Anna A.

doi:10.1136/archdischild-2014-306192

Cited by 14 publications

(12 citation statements)

References 34 publications

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“…Local inflammation can generate a setting of hypoxia or ischemia that would alter the transportation of both nutrients and respiratory gases to the unborn fetus, which can result in cranial malformation owing to an inadequate supply of nutrients and oxygen. 23 Oxidative stress caused by hypoxia also leads to structural and functional alterations in intrauterine development. 24 This scenario is often observed in cases of placental malfunction due to various etiologies and to prolonged or premature labor.…”

Section: Discussionmentioning

confidence: 99%

Association of Malaria Infection During Pregnancy With Head Circumference of Newborns in the Brazilian Amazon

et al. 2019

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Key Points Question Is malaria infection during pregnancy associated with fetal head growth? Findings In 2 cohort studies of 4291 pregnancies, falciparum malaria during pregnancy was significantly associated with the occurrence of decreased head circumference in newborns. Placental malaria characterized by increased placental syncytial nuclear aggregates, leukocyte infiltration, and imbalanced angiogenic factors was associated with the incidence of decreased head circumference. Meaning Plasmodium falciparum infection during pregnancy was associated with altered fetal head development, with possible consequences for fetal neurologic development.

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Section: Discussionmentioning

confidence: 99%

Association of Malaria Infection During Pregnancy With Head Circumference of Newborns in the Brazilian Amazon

et al. 2019

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“…13 Few clinical studies have examined the role of specific perinatal infections and inflammation as independent risk factors for NE, although an important role is hypothesised. 14 …”

Section: Introductionmentioning

confidence: 99%

Perinatal risk factors for neonatal encephalopathy: an unmatched case-control study

Tann

Nakakeeto

Willey

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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ObjectiveNeonatal encephalopathy (NE) is the third leading cause of child mortality. Preclinical studies suggest infection and inflammation can sensitise or precondition the newborn brain to injury. This study examined perinatal risks factor for NE in Uganda.DesignUnmatched case–control study.SettingMulago National Referral Hospital, Kampala, Uganda.Methods210 term infants with NE and 409 unaffected term infants as controls were recruited over 13 months. Data were collected on preconception, antepartum and intrapartum exposures. Blood culture, species-specific bacterial real-time PCR, C reactive protein and placental histology for chorioamnionitis and funisitis identified maternal and early newborn infection and inflammation. Multivariable logistic regression examined associations with NE.ResultsNeonatal bacteraemia (adjusted OR (aOR) 8.67 (95% CI 1.51 to 49.74), n=315) and histological funisitis (aOR 11.80 (95% CI 2.19 to 63.45), n=162) but not chorioamnionitis (aOR 3.20 (95% CI 0.66 to 15.52), n=162) were independent risk factors for NE. Among encephalopathic infants, neonatal case fatality was not significantly higher when exposed to early neonatal bacteraemia (OR 1.65 (95% CI 0.62 to 4.39), n=208). Intrapartum antibiotic use did not improve neonatal survival (p=0.826). After regression analysis, other identified perinatal risk factors (n=619) included hypertension in pregnancy (aOR 3.77), male infant (aOR 2.51), non-cephalic presentation (aOR 5.74), lack of fetal monitoring (aOR 2.75), augmentation (aOR 2.23), obstructed labour (aOR 3.8) and an acute intrapartum event (aOR 8.74).ConclusionsPerinatal infection and inflammation are independent risk factors for NE in this low-resource setting, supporting a role in the aetiological pathway of term brain injury. Intrapartum antibiotic administration did not mitigate against adverse outcomes. The importance of intrapartum risk factors in this sub-Saharan African setting is highlighted.

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“…In clinical studies, factors associated with intrauterine infection and inflammation, such as prolonged rupture of membranes, have been shown to be associated with NE [ 5 ], and the presence of placental inflammation/infection has been shown to be independently associated with an increased risk of NE in both high- and low-income settings [ 18 , 19 ]. While few clinical studies have examined the role of specific infections and inflammation as independent risk factors for NE, an important role is hypothesized [ 20 , 21 ].…”

mentioning

confidence: 99%

Neonatal Encephalopathy With Group B Streptococcal Disease Worldwide: Systematic Review, Investigator Group Datasets, and Meta-analysis

Martinello

Sadoo

Lawn

et al. 2017

Clinical Infectious Diseases

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BackgroundNeonatal encephalopathy (NE) is a leading cause of child mortality and longer-term impairment. Infection can sensitize the newborn brain to injury; however, the role of group B streptococcal (GBS) disease has not been reviewed. This paper is the ninth in an 11-article series estimating the burden of GBS disease; here we aim to assess the proportion of GBS in NE cases.MethodsWe conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups reporting GBS-associated NE. Meta-analyses estimated the proportion of GBS disease in NE and mortality risk. UK population-level data estimated the incidence of GBS-associated NE.ResultsFour published and 25 unpublished datasets were identified from 13 countries (N = 10436). The proportion of NE associated with GBS was 0.58% (95% confidence interval [CI], 0.18%–.98%). Mortality was significantly increased in GBS-associated NE vs NE alone (risk ratio, 2.07 [95% CI, 1.47–2.91]). This equates to a UK incidence of GBS-associated NE of 0.019 per 1000 live births.ConclusionsThe consistent increased proportion of GBS disease in NE and significant increased risk of mortality provides evidence that GBS infection contributes to NE. Increased information regarding this and other organisms is important to inform interventions, especially in low- and middle-resource contexts.

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Is infection a factor in neonatal encephalopathy?

Cited by 14 publications

References 34 publications

Association of Malaria Infection During Pregnancy With Head Circumference of Newborns in the Brazilian Amazon

Association of Malaria Infection During Pregnancy With Head Circumference of Newborns in the Brazilian Amazon

Perinatal risk factors for neonatal encephalopathy: an unmatched case-control study

Neonatal Encephalopathy With Group B Streptococcal Disease Worldwide: Systematic Review, Investigator Group Datasets, and Meta-analysis

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