This press release was just issued:

U.S. Department of Health and Human Services

NATIONAL INSTITUTES OF HEALTH

NIH News

National Institute of Child Health
and Human Development (NICHD)
http://www.nichd.nih.gov/

EMBARGOED FOR RELEASE
Tuesday, November 16, 2004
4:00 p.m. ET

CONTACTS:
Robert Bock or
Marianne Glass Miller
301-496-5133


INFECTION PUTS EXTREMELY LOW BIRTH WEIGHT INFANTS AT RISK FOR DEVELOPMENTAL
DELAYS

Extremely low birth weight infants -- the tiniest category of premature
infants
-- are much more likely to experience developmental impairments if they
acquire
an infection during the newborn period, according to a study by the Neonatal

Research Network of the National Institute of Child Health and Human
Development, one of the National Institutes of Health. The developmental
impairments were seen regardless of the type of infection -- whether it
occurred
in the brain, blood or intestines.

The study was conducted by Barbara J. Stoll, M.D., of the Emory University
School of Medicine in Atlanta, Georgia and her colleague. Appearing in the
November 17 "Journal of the American Medical Association," the study
reported
that 65 percent of a group of extremely low birth weight infants had
developed
at least one infection during their hospitalizations after birth. These
infants
were more likely to have an impairment than were infants who had not
developed
an infection.

"This study shows us that successfully treating an extremely low birth
weight
infant's infection does not automatically ensure that the infant will do
well,"
said NICHD Director Duane Alexander, M.D. "Parents and health care workers
need
to monitor these children carefully as they grow, and be ready to provide
them
with developmental and educational services, if necessary."

According to the U.S. Centers for Disease Control and Prevention, there were

60,326 very low birth weight infants born in 2002, or 1.46 percent of the
4,021,726 total births for that year. Infants are classified as low birth
weight
if they are born weighing less than 2500 grams (about 5.5 pounds) and very
low
birth weight if they weigh less than1500 grams (about3.3 pounds). In the
current
study, the researchers analyzed the records of extremely low birth weight
(ELBW)
infants -- those weighing less than 1000grams, or 2.2 pounds. Yearly
statistics
are not compiled on ELBW infants. Study co-author Rosemary Higgins, M.D., of

NICHD's Pregnancy and Perinatology Branch, estimated that as many as 50
percent
of newborns below 1500 grams may fall into the ELBW category.

The study enrolled infants weighing from 401 to 1000 grams at birth. In all,

6,093 infants were evaluated for this study. The infants were evaluated when

they were between 18 and 22 months corrected gestational age -- equivalent
to
the age they would be had they been born at term. The researchers found that
the
majority of these infants (65 percent) had at least one infection during
their
stay in the hospital after birth.

According to Dr. Higgins, about 47 percent of the children with infections
had
some form of delay in development or a physical or mental impairment. These
impairments consisted of either cerebral palsy, a visual impairment, a
hearing
impairment, or were manifested as low scores on tests of infant mental
development or motor skills.

Dr. Higgins added that although infants with infections were more likely to
have
such impairments, infants who did not have infections also had a high rate
of
impairment, at about 29 percent.

"This is a high risk, fragile population of infants," she said.

As expected, meningitis -- an infection of the membrane covering the brain
and
spinal cord -- was associated with neurological impairments. For example, in
the
group that had meningitis with or without sepsis (an infection of the blood)
38
percent had low scores for mental development, compared to 22 percent of the

children who did not have an infection. Children in this group were also
more
likely to have cerebral palsy (19 percent) than were children who did not
have
an infection (8 percent).

Moreover, children with infections that did not directly involve the nervous

system were also more likely to have an impairment involving the nervous
system.
Of the infants who had sepsis alone, 37 percent had low mental development
scores and 17 percent had cerebral palsy. Of the children without an
infection,
22 percent had low mental development scores, and 8 percent had cerebral
palsy.
Of the infants who had both sepsis and necrotizing enterocolitis (an
intestinal
infection), 42 percent received low mental development scores, compared to
22
percent who had not had an infection.

Dr. Higgins explained that before the current study, researchers had known
that
ELBW infants were more likely to experience problems with the brain and
nervous
system, but did not know the extent of the problems. This study is the first
to
show how widespread the problems are, and that they appear more often in
children who have had an infection.

The study authors called for additional research to determine how infections

might injure brain tissue in this group of infants, as well as research to
prevent infection and to prevent such nervous system damage from occurring
once
an infection had occurred.

The NICHD is part of the National Institutes of Health (NIH), the biomedical

research arm of the federal government. NIH is an agency of the U.S.
Department
of Health and Human Services. The NICHD sponsors research on development,
before
and after birth; maternal, child, and family health; reproductive biology
and
population issues; and medical rehabilitation. NICHD publications, as well
as
information about the Institute, are available from the NICHD Web site,
<http://www.nichd.nih.gov>, or from the NICHD Information Resource Center,
1-
800-370-2943; e-mail [log in to unmask]


Ellen Penchuk, IBCLC, RLC

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