Timing of sepsis is an important risk factor for white matter abnormality in extremely premature infants with sepsis

Background: Systemic infection is a major upstream mechanism for white matter abnormality (WMA). Our aim was to evaluate the risk factors for moderate-to-severe WMA in extremely premature infants (gestational age < 28 weeks) with neonatal sepsis. Methods: Extremely premature infants with culture-proven sepsis between 2006 and 2015 in a tertiary neonatal intensive care unit were classified as having none-to-mild or moderate-to severe WMA based on WM scores of brain magnetic resonance imaging at the term equivalent age. Various risk factors for WMA were analyzed. Results: Sixty-three infants (87.5%) had none-to-mild WMA, and nine infants (12.5%) had moderate-to-severe WMA. Multivariate logistic regression analysis revealed that postmenstrual age (PMA) at sepsis diagnosis (OR: 0.640, 95% CI: 0.435-0.941, p = 0.023) and PMA at sepsis diagnosis <28 weeks (OR: 9.232, 95% CI: 1.020-83.590, p = 0.048) were independently associated with moderate-to-severe WMA. PMA at sepsis diagnosis had a significant negative correlation with WM scores (r = -0.243, p = 0.039). Conclusion: PMA at sepsis diagnosis might be an important risk factor for moderate-to-severe WMA in extremely premature infants with postnatal sepsis, especially before PMA 28 weeks. Infants who suffer from sepsis before PMA 28 weeks might need additional therapy for neuroprotection. Copyright (C) 2017, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC.