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Premature infants who have recurrent infections face an increased risk of progressive white matter injury, according to a report in the August issue of Pediatrics.

Premature infants who have recurrent infections face an increased risk of progressive white matter injury, according to a report in the August issue of Pediatrics.

"This work builds on the previous observations by Stoll and others that infections in premature newborns are an important risk factor for adverse neurodevelopmental outcomes," Dr. Steven P. Miller from the University of California, San Francisco, and the University of British Columbia, Vancouver, told Reuters Health.

Dr. Miller and colleagues sought to identify clinical risk factors for progressive white matter injury in 133 premature infants enrolled in a cohort study examining MRI predictors of neurodevelopmental outcomes.

Newborns who showed progressive white matter injury had a high incidence of infections, blood pressure instability, and chronic lung disease, the authors report. In contrast, increasing gestational age at birth appeared to be protective.

Recurrent infection increased the risk of progressive white matter injury by 8.3-fold, after adjustment for gestational age at birth, and 6.22-fold, after additional adjustment for the presence of chronic lung disease, the researchers note. Adjustment for gestational age at birth erased the significant association between chronic lung disease and progressive white matter injury.

"The big question we are left with is whether improved treatment or prevention of postnatal infections will prevent brain injury and improve outcomes in premature newborns," Dr. Miller said. "Randomized clinical trials would be needed to answer these important questions."

"It is important to acknowledge the contribution of the families of premature newborns that contribute to research studies," Dr. Miller added. "These families make very important contributions to improving the care of sick newborns, in what are often very stressful times for them."

Pediatrics 2008;122:299-305