Early-onset neonatal infection and cognitive impairment: a nationwide cohort study.

OBJECTIVE

To study the effect of early-onset neonatal infection on long-term cognitive impairment including intellectual disability and special educational needs.

METHODS

A nationwide register-based cohort study was conducted including near-term to term children born between 1997 and 2013 with follow-up until 2021. Early-onset infection was defined as an invasive bacterial infection within the first week after birth defined by either physician-assigned diagnoses or bacterial pathogens cultured from blood or cerebrospinal fluid. Outcomes included diagnoses of intellectual disability and special educational needs. Associations were estimated by adjusted HRs (aHR) or unadjusted incidence rate ratios (IRR), when exposures and outcomes were rare. Additional analyses were conducted, including sibling-matched analyses and subgroup analyses considering only children with culture-positive infection.

RESULTS

Among 993 363 children, 8267 (0.8%) had sepsis and 152 (<0.1%) had meningitis. Of these, 260 had culture-positive sepsis and 31 had culture-positive meningitis. Early-onset sepsis was associated with an increased risk of intellectual disability (aHR: 2.24, 95% CI 1.93 to 2.59) and special educational needs (aHR: 1.49, 95% CI 1.40 to 1.59). Early-onset meningitis was associated with higher risks of both intellectual disability (IRR: 7.75, 95% CI 3.34 to 15.27) and special educational needs (aHR: 2.95, 95% CI 2.06 to 4.22). The associations remained consistent across multiple additional analyses, including sibling-matched analyses and subgroup analyses limited to culture-positive infections.

CONCLUSIONS

Early-onset neonatal infection in near-term to term children was associated with an increased risk of long-term cognitive impairment including both intellectual disability and special educational needs.