Citations 3
Cortical surface area, thalamic nuclei volume, and associations with neurocognitive functioning in 6–13-year-old children born late preterm and full term
Nelson, Paige M. , Harmon, Heidi M., Brumbaugh, Jane E. , Nopoulos, Peg , Maller, Jerome J., Magnotta, Vincent A. , Nopoulos, Peggy C, Harmon, Heidi M. , Maller, Jerome J. , Momany, Allison M.
No container title available | September 17, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Abstract Background Late preterm (LP) children (34 0/7 – 36 6/7 weeks of gestation) are at risk for neurocognitive challenges, yet the neuroanatomic and functional disruptions underlying these developmental differences remain poorly understood. Purpose or Hypothesis Investigate (1) regional differences in cortical surface area and thalamic nuclei volume and (2) structural variations that may explain heterogeneity in neurocognitive functioning in LP versus full term (FT) school-aged children, using two complementary approaches: a vertex-wise analysis of cortical surface area and a region-of-interest volumetric analysis of thalamic nuclei. Study Type Secondary analysis of a prospective observational cohort study. Population or Subjects 48 LP and 72 FT children aged 6–13 years. Field Strength/Sequence 3T; Sagittal T1-weighted MP-RAGE and axial T2-weighted 3D SPACE. Assessment FreeSurfer 7.4.1 was used to parcellate cortical regions (Destrieux atlas) and segment thalamic nuclei (25 nuclei). Neurocognitive functioning was assessed across four domains: hyperactivity/inattention (Pediatric Behavior Scale), processing speed (WISC-IV), working memory (WISC-III), and visual-spatial perception (Benton JLO). Statistical Tests Independent samples t-tests for group comparisons; vertex-wise GLMs for cortical surface analyses with false discovery rate (FDR) correction; and multiple linear regression for thalamic nuclei analyses with FDR-corrected q < 0.05. Results Vertex-wise analyses revealed regional differences in cortical surface area between LP and FT children in both hemispheres, along with associations between surface area in several cortical regions and hyperactivity/inattention, working memory, and visual-spatial perception. In contrast, using an ROI approach, thalamic nuclei volumes did not differ between groups and were not associated with any neurocognitive domains. Conclusion LP birth may be associated with subtle, region-specific bidirectional left and right hemispheric cortical surface area differences rather than widespread structural alterations in middle childhood, with regional macrostructural measures associated with individual differences in neurocognitive functioning.
Social Determinants of Health and Redirection of Care for Infants Born Extremely Preterm
Bann, Carla , Vohr, Betty R. , McGowan, Elisabeth C. , Harmon, Heidi M. , Hintz, Susan R. , Duncan, Andrea F. , Polin, Richard A. , Laptook, Abbot R. , Mayne, Julie, Lamberson, Vita, Keszler, Mary Lenore, Hensman, Angelita M. , Vieira, Elisa , Pierre, Lucille St., Burke, Robert T., Alksninis, Barbara, Leach, Teresa M., Knoll, Andrea M., Moffat, Stephanie, Newman, Nancy S., Wilson-Costello, Deanne E. , Siner, Bonnie S., Friedman, Harriet, Truog, William E., Pallotto, Eugenia K. , Kilbride, Howard W. , Gauldin, Cheri, Holmes, Anne, Johnson, Kathy, Scott, Allison, Parimi, Prabhu S., Gaetano, Lisa, Merhar, Stephanie L. , Schibler, Kurt, Poindexter, Brenda B. , Cahill, Tanya E., Dudley, Juanita , Gratton, Teresa L., Grisby, Cathy, Henkes, Lisa, Kirker, Kristin, Stacey, Sara, Wuertz, Sandra, Cotten, C. Michael , Goldberg, Ronald N., Goldstein, Ricki F., Malcolm, William , Ashley, Patricia L., Mago-Shah, Deesha, Finkle, Joanne, Fisher, Kimberley A. , Gustafson, Kathryn E. , Bose, Carl , Bernhardt, Janice, Bose, Gennie, Clark, Cindy, Wereszczak, Janice, Warner, Diane, Talbert, Jennifer, Kicklighter, Stephen D. , Bentley, Alexandra, Edwards, Laura , Rhodes-Ryan, Ginger, Carlton, David P., Loggins, Yvonne, Adams‐Chapman, Ira , Bottcher, Diane I., Carter, Sheena L., Hale, Ellen C., Kendrick-Allwood, Salathiel, Laursen, Judith, LaRossa, Maureen Mulligan, Mackie, Colleen, Sanders, Amy , Smikle, Gloria V., Wineski, Lynn, Walsh, Michele C. , Bremer, Andrew A. , Higgins, Rosemary D. , Archer, Stephanie Wilson , Sokol, Gregory M. , Papile, L.A., Herron, Dianne E., Hines, Abbey C. , Lytle, Carolyn, Smiley, Lucy, Wilson, Leslie Dawn, Watkins, Donna, Gunn, Susan, Joyce, Jeff, Tyson, Jon E., Kennedy, Kathleen A. , Mosquera, Ricardo A. , Eason, Elizabeth, Stephens, Emily K. , Alaniz, Nora I., Allain, Elizabeth, Arldt-McAlister, Julie, Boricha, Fatima, Burson, Katrina, Garcia, Carmen, Hall, Donna J., John, Janice , Jones, Patrick M., Lillie, M. Layne, Mason, Carrie M., Martin, Karen , Martin, Sara C., McDavid, Georgia E., McKee, Shannon L. , Poe, Michelle, Rennie, Kimberly , Reddy, Tina, Rodgers, Shawna, Siddiki, Saba Khan, Sperry, Daniel K., Tate, Patti L. Pierce, Wright, Sharon L., Zanger, Dinorah, Jadcherla, Sudarshan R. , Timan, Christopher J., Luzader, Patricia, Batterson, Nancy, Baugher, Hallie, Beckford, Demi R., Burkhardt, Stephanie, Carey, Helen , Chao, Michelle, Cira, Courtney, Clark, Erna, DeSantis, Brittany, Fowler, Aubrey, Gutentag, Julie, Grothause, Jennifer L., Hague, Cole , Levengood, Katelyn, Marzec, Laura, McCool, Jacqueline, Miller, Bethany, Nelin, Mary Ann , Park, Courtney, Purnell, Jessica, Seabrook, Ruth , Shadd, Julie C., Small, Kristi , Stein, Melanie, Sullivan, Margaret, Sullivan, Rox Ann, Warnimont, Kyrstin, Yossef‐Salameh, Lina, Fearns, Erin, Wallace, Dennis, Auman, Jeanette O’Donnell , Gabrio, Jenna, Huitema, Carolyn M. Petrie , Zaterka-Baxter, Kristin M. , Meurs, Krisa P. Van , Chock, Valerie Y. , Stevenson, David K. , Ball, M. Bethany , Bahmani, Dona, Adams, Marian M. , Bentley, Barbara, DeAnda, Maria Elena, DeBattista, Anne M., Earhart, Beth, Huffman, Lynne C. , Krueger, Casey E., Lucash, Ryan E., Proud, Melinda S., Reichert, Elizabeth N., Weiss, Hali E., Williams, R. Jordan , Peralta-Carcelén, Myriam , Collins, Monica V., Cosby, Shirley S., Bailey, Kirstin J., Biasini, Fred J., Chopko, Stephanie A., Domnanovich, Kristy A., Jno-Finn, Chantel J., Ladinsky, Morissa, Moses, Mary Beth, Buie, Cindie, McNair, Tara E., Phillips, Vivien A., Preskitt, Julie , Rector, Richard V., Stringer, Kimberlly, Whitley, Sally, Chapman, Sheree York, Devaskar, Uday, Garg, Meena, Purdy, Isabell B., Chanlaw, Teresa , Geller, Rachel , Johnson, Karen, Eastman, Diane L., Walker, Jacky R., Goeke, Claire A., Schmelzel, Mendi L., Faruqui, Sarah E., Coulter, Brenda J., Schrimper, Bailey M., Jellison, Sydney S., Knosp, L.K., Arnold, Sandra J., Andrews, Haley A., Ellsbury, Dan L., Bass, Donia B., Tud, Tracy L., Baack, Michelle , Richards, Laurie A., Henning, Megan M., Elenkiwich, Chelsey, Broadbent, Megan, Muyden, Sarah Van, Brodkorb, Aimee, Watterberg, Kristi L. , Fuller, Janell, Ohls, Robin K. , Lacy, Conra Backstrom, Hartenberger, Carol, Beauman, Sandra Sundquist , Hanson, Mary, Lowe, Jean, Kuan, Elizabeth, Eichenwald, Eric C. , Abbasi, Soraya, Chaudhary, Aasma S. , Cucinotta, Dara M., Bernbaum, Judy, Gerdes, Marsha , Ghavam, Savin, Hurt, Hallam, Snyder, Jonathan, Ziolkowski, Kristina, Dhawan, Megan , Booth, Lauren, Catts, Christine, D’Angio, Carl T., Guillet, Ronnie , Myers, Gary J. , Reynolds, Anne Marie , Wadkins, Holly I.M., Sacilowski, Michael G., Jensen, Rosemary L., Merzbach, Joan, Zorn, William, Farooq, Osman , Maffett, Dee, Williams, Ashley, Hunn, Julianne, Guilford, Stephanie , Yost, Kelley, Rowan, Mary, Prinzing, Diane, Bowman, Melissa, Reubens, Linda J., Scorsone, Ann Marie, Harley-McAndrew, Michelle, Fallone, Caitlin, Binion, Kyle, Orme, Constance, Sabaratnam, Premini , Jones, Rachel , Boylin, Elizabeth, Rochez, Daisy, Li, Emily, Kachelmeyer, Jennifer , McKee, Kimberly G., Coleman, Kelly R., Moreland, Melissa, Cavanaugh, Brenna, Wyckoff, Myra H. , Heyne, Roy J. , Vasil, Diana M., Adams, Sally S., Chen, Lijun , Leon, Maria Magdalena, Duran, Joanne, Eubanks, Frances, McDougald, Rebecca, Pavageau, Lara, Sepulveda, Pollieanna , Guzman, Alicia, Harrod, M. J. E., Heyne, Elizabeth T., Madden, Linda A., Lee, Lizette E. , Puentez, Anna E., Tolentino-Plata, Kristine , Boatman, Cathy Twell, Vera, Azucena, Waterbury, Jillian, Yoder, Bradley A. , Baserga, Mariana , Faix, Roger G., Minton, Stephen D., Sheffield, Mark J., Rau, Carrie A., Baker, Shawna, Burnett, Jill, Christensen, Susan, Bledsoe, Laura Cole, Cunningham, Sean D. , Davis, Brandy, Elmont, Jennifer O., Hall, Becky, Jensen, Erika R., Loertscher, Manndi C., Marchant, Trisha, Maxson, Earl, McGrath, Kandace M., Mickelsen, Hena G., Morshedzadeh, Galina, Parry, Dilys M. , Reich, Brixen A., Schaefer, Susan T., Stout, Kelly, Stuart, Ashley L., Weaver-Lewis, Kimberlee, Winter, Sarah , Woodbury, Kathryn D., Osborne, Karen A., Bird, Karie, Coleman, Kathleen, Francom, Barbara L., Jordan, Jamie, Steffen, Mike, Tice, Katherine, Shankaran, Seetha , Natarajan, Girija , Pappas, Athina, Sood, Beena G. , Bajaj, Monika , February, Melissa, Agarwal, Prashant , Chawla, Sanjay , Bara, Rebecca, Childs, Kirsten, Woldt, Eunice, Goldston, Laura A., Wiggins, Stephanie A., Christensen, Mary, Carlson, Martha, White, Diane F., Baack, Michelle L , Brumbaugh, Jane E. , Bell, Edward F. , Travers, Colm P. , Carlo, Waldemar A. , Keszler, Martin , Watson, Victoria E. , Hibbs, Anna Maria , Kim, Jae Hong , Yolton, Kimberly , Russell, David G. , Laughon, Matthew Maxwell , White, Donna, Patel, Ravi M. , Stoll, Barbara J. , Sewell, Elizabeth , Maitre, Nathalie L. , (deceased), Jeff Joyce, Khan, Amir M , Rysavy, Matthew A. , Dempsey, Allison G. , White, Michelle, Sánchez, Pablo J. , Slaughter, Jonathan L. , Nelin, Leif Daniel , Yeates, Keith Owen , Fortney, Christine A. , Keim, Sarah A. , Newton, Julia L. , Pietruszewski, Lindsay , Das, Abhik , Gantz, Marie G. , Wiener, Laura Elizabeth , Crawford, Margaret M. , Newman, Jamie E. , Parlberg, Lindsay M. , Taylor, Heather Lee , Ambalavanan, Namasivayam , Colaizy, Tarah T. , Widness, John A. , DeMauro, Sara B. , Schmidt, Barbara Kristina , Kirpalani, Haresh Murli , Mancini, Toni, Lakshminrusimha, Satyan , Kent, Alison , Brion, Luc P. , Leon, Maria M. De, Harrod, Michelle, Parry, D. Melody, Coleman, Kathleen, Barks, John
JAMA Pediatrics | March 11, 2024 | Volume: 178 | Issue: 5 | Pages: 454
10.1001/jamapediatrics.2024.0125
ImportanceRedirection of care refers to withdrawal, withholding, or limiting escalation of treatment. Whether maternal social determinants of health are associated with redirection of care discussions merits understanding.ObjectiveTo examine associations between maternal social determinants of health and redirection of care discussions for infants born extremely preterm.Design, Setting, and ParticipantsThis is a retrospective analysis of a prospective cohort of infants born at less than 29 weeks’ gestation between April 2011 and December 2020 at 19 National Institute of Child Health and Human Development Neonatal Research Network centers in the US. Follow-up occurred between January 2013 and October 2023. Included infants received active treatment at birth and had mothers who identified as Black or White. Race was limited to Black and White based on service disparities between these groups and limited sample size for other races. Maternal social determinant of health exposures were education level (high school nongraduate or graduate), insurance type (public/none or private), race (Black or White), and ethnicity (Hispanic or non-Hispanic).Main Outcomes and MeasuresThe primary outcome was documented discussion about redirection of infant care. Secondary outcomes included subsequent redirection of care occurrence and, for those born at less than 27 weeks’ gestation, death and neurodevelopmental impairment at 22 to 26 months’ corrected age.ResultsOf the 15 629 infants (mean [SD] gestational age, 26 [2] weeks; 7961 [51%] male) from 13 643 mothers, 2324 (15%) had documented redirection of care discussions. In unadjusted comparisons, there was no significant difference in the percentage of infants with redirection of care discussions by race (Black, 1004/6793 [15%]; White, 1320/8836 [15%]) or ethnicity (Hispanic, 291/2105 [14%]; non-Hispanic, 2020/13 408 [15%]). However, after controlling for maternal and neonatal factors, infants whose mothers identified as Black or as Hispanic were less likely to have documented redirection of care discussions than infants whose mothers identified as White (Black vs White adjusted odds ratio [aOR], 0.84; 95% CI, 0.75-0.96) or as non-Hispanic (Hispanic vs non-Hispanic aOR, 0.72; 95% CI, 0.60-0.87). Redirection of care discussion occurrence did not differ by maternal education level or insurance type.Conclusions and RelevanceFor infants born extremely preterm, redirection of care discussions occurred less often for Black and Hispanic infants than for White and non-Hispanic infants. It is important to explore the possible reasons underlying these differences.
Incidence of and Neurodevelopmental Outcomes After Late-Onset Meningitis Among Children Born Extremely Preterm
Bell, Edward F. , Barbara, T. , Greenberg, Rachel G. , Stoll, Barbara J. , DeMauro, Sara B. , Harmon, Heidi M. , Hintz, Susan R. , Das, Abhik , Puopolo, Karen M. , Bailey, Kirstin J., Biasini, Fred J., Chopko, Stephanie A., Collins, Monica V., Cosby, Shirley S., Johnston, Kristen C. , Moses, Mary Beth, Nelson, Kathleen G., Patterson, Cryshelle S., Peralta-Carcelén, Myriam , Phillips, Vivien A., Preskitt, Julie , Rector, Richard V., Whitley, Sally, Alksninis, Barbara, Bishop, Carmena, Burke, Robert T., Caskey, Melinda, Hensman, Angelita M. , Hoffman, Laurie , Johnson, Katharine, Keszler, Mary Lenore, Knoll, Andrea M., Lamberson, Vita, Laptook, Abbot R. , Leach, Theresa M., Little, Emilee, McGowan, Elizabeth C., Pierre, Lucille St., Stephens, Bonnie E., Ventura, Suzy, Vieira, Elisa , Vohr, Betty R. , Coleman, Kelly R., Guilford, Stephanie , Hartley-McAndrew, Michelle, Li, Emily, Reynolds, Anne Marie , Sacilowski, Michael G., Williams, Ashley, Zorn, William, Bhola, Monika , Fanaroff, Avroy A., Friedman, Harriet, Newman, Nancy S., Siner, Bonnie S., Walsh, Michele C. , Wilson-Costello, Deanne E. , Yalcinkaya, Gulgun, Caplan, Michael S. , Beiersdorfer, Traci , Bridges, Kate, Cahill, Tanya E., Donovan, Edward F., Dudley, Juanita , Fischer, Estelle E., Gratton, Teresa L., Grisby, Cathy, Hayes, Devan, Hessling, Jody, Jackson, Lenora, Kallapur, Suhas G. , Kirker, Kristin, Merhar, Stephanie L. , Mincey, Holly L., Muthig, Greg, Poindexter, Brenda B. , Schibler, Kurt, Stacey, Sara, Steichen, Jean J., Tepe, Stacey, Thompson, Julia, Mersmann, Marcia Worley, Wuertz, Sandra, Polin, Richard A. , Adams, Sally S., Leon, Maria Magdalena, Eubanks, Frances, Guzman, Alicia, Hensley, Gaynelle, Heyne, Elizabeth T., Heyne, Roy J. , Hickman, Jackie F., Lee, Lizette E. , Leps, Melissa H., Madden, Linda A., McDougald, E. Rebecca, Miller, Nancy A., Morgan, Janet S., Pavageau, Lara, Salhab, Walid A., Sepulveda, Pollieanna , Boatman, Catherine Twell, Vasil, Diana M., Waterbury, Jillian, Wyckoff, Myra H. , Ashley, Patricia L., Auten, Kathy J., Cotten, C. Michael , Finkle, Joanne, Fisher, Kimberley A. , Goldberg, Ronald N., Goldstein, Ricki F., Grimes, Sandra, Gustafson, Kathryn E. , Lohmeyer, Melody B., Malcolm, William , Adams‐Chapman, Ira , Blackwelder, Ann M., Bottcher, Diane I., Carlton, David P., Carter, Sheena L., Hale, Ellen C., Kendrick-Allwood, Salathiel, Laursen, Judith, Loggins, Yvonne, Mackie, Colleen, LaRossa, Maureen Mulligan, Sanders, Amy , Seabrook, Irma, Smikle, Gloria V., Wineski, Lynn, Akpa, Esther, Alaniz, Nora I., Allain, Elizabeth, Arldt-McAlister, Julie, Bradt, Pamela J., Burson, Katrina, Dieterich, Susan, Duncan, Andrea F. , Eason, Elizabeth, Evans, Patricia W., Harris, Beverly Foley, Franco, Claudia I., Garcia, Carmen, Hall, Donna J., Jiménez, Margarita, John, Janice , Jones, Patrick M., Kennedy, Kathleen A. , Siddiki, Saba Khan, Lillie, Layne M., Major-Kincade, Terri L., Martin, Sara C., McDavid, Georgia E., McKee, Shannon L. , Morris, Brenda H., Orekoya, Patricia Ann, Pedrozza, Claudia, Perez, Carrie M., Tate, Patti L. Pierce, Reddoch, Stacey, Rodgers, Shawna, Simmons, Maegan C., Sperry, Daniel K., Stephens, Emily K. , Tyson, Jon E., Whitely, Laura L., Wright, Sharon L., Dusick, Anna M., Gunn, Susan, Hamer, Faithe, Herron, Dianne E., Hines, Abbey C. , Joyce, Jeffery, Lemons, James A., Lytle, Carolyn, Miller, Lucy , Minnich, Heike M., Papile, L.A., Richard, Leslie, Smiley, Lucy, Sokol, Gregory M. , Wilson, Leslie Dawn, Acarregui, Michael J., Colaizy, Tarah T. , Eastman, Diane L., Goeke, Claire A., Johnson, Karen, Krutzfield, Nancy J., Schmelzel, Mendi L., Walker, Jacky R., Bass, Donia B., Ellsbury, Dan L., Tud, Tracy L., Bauer, Charles R., Duara, Shahnaz , Everett‐Thomas, Ruth , Fajardo-Hiriart, Sylvia, Eguaras, Silvia M. Frade, Garcia, Andrea, Berkovits, Michelle Harwood, Pierre, Helina, Riguard, Arielle, Stoerger, Alexandra, Gaetano, Lisa, Gauldin, Cheri, Holmes, Anne, Johnson, Kathy, Kilbride, Howard W. , Pallotto, Eugenia K. , Parimi, Prabhu S., Scott, Allison, Truog, William E., Besner, Gail E. , Clark, Erna, Gutentag, Julie, Jadcherla, Sudarshan R. , Luzader, Patricia, Park, Courtney, Shadd, Julie C., Stein, Melanie, Sullivan, Margaret, Bremer, Andrew A. , Higgins, Rosemary D. , Archer, Stephanie Wilson , Abbasi, Soraya, Bernbaum, Judy, Catts, Christine, Chaudhary, Aasma S. , Cucinotta, Dara M., Eichenwald, Eric C. , Gerdes, Marsha , Ghavam, Sarvin, Hurt, Hallam, Snyder, Jonathan, Vangala, Sarith, Ziolkowski, Kristina, Johnson, Julie Babish, Binion, Kyle, Bowman, Melissa, Burnell, Erica, D’Angio, Carl T., Fallone, Caitlin, Farooq, Osman , Guillet, Ronnie , Horihan, Cassandra A., Hunn, Julianne, Hust, Diane, Jensen, Rosemary L., Jones, Rachel , Kachelmeyer, Jennifer , Kushner, Emily, Maffett, Deanna, McKee, Kimberly G., Merzbach, Joan, Myers, Gary J. , Orme, Constance, Phelps, Dale L. , Dm, Prinzing, Reubens, Linda J., Rochez, Daisy, Rowan, Mary, Sabaratnam, Premini, Scorsone, Ann Marie, Wadkins, Holly I.M., Yost, Kelley, Zwetsch, Lauren, Gabrio, Jenna, Hastings, Betty K., LeBlond, David, Auman, Jeanette O’Donnell , Huitema, Carolyn M. Petrie , Poole, W. Kenneth, Wallace, Dennis, Zaterka-Baxter, Kristin M. , Baack, Michelle , Broadbent, Megan, Elenkiwich, Chelsey, Henning, Megan M., Hogden, Laurie A., Adams, Marian M. , Bahmani, Dona, Ball, M. Bethany , Bentley, Barbara, Bruno, Elizabeth F., Chock, Valerie Y. , Davis, Alexis S. , DeAnda, Maria Elena, DeBattista, Anne M., Earhart, Beth, Huffman, Lynne C. , Ismael, Magdy, Kohn, Jean G., Krueger, Casey E., Lee-Ancajas, Julie C., Lowe, Janice, Lucash, Ryan E., Palmquist, Andrew W., Patel, Jessica, Proud, Melinda S., Reichert, Elizabeth N., Sivakumar, Dharshi, John, Nicholas H. St., Stevenson, David K. , Meurs, Krisa P. Van , Wager, Natalie, Williams, R. Jordan , Weiss, Hali E., Brussa, Ana K. , Church, Paige , Fiascone, John M., Frantz, Ivan D. , Furey, Anne, Kurfiss, Anne, MacKinnon, Brenda L., McGowan, Elisabeth C. , Nylen, Ellen, Sibley, Cecelia, Chanlaw, Teresa , Devaskar, Uday, Garg, Meena, Geller, Rachel , Purdy, Isabell B., Arnell, Kathy, Demetrio, Clarence, Finer, Neil N., Fuller, Martha G. , Henderson, Christopher, Kaegi, David, Rasmussen, Maynard R., Rich, Wade , Vaucher, Yvonne E. , Wozniak, Paul R., Bernhardt, Janice, Bose, Carl , Bose, Gennie, Clark, Cynthia L., Warner, Diane, Wereszczak, Janice, Lacy, Conra Backstrom, Fuller, Janell, Hanson, Mary, Hartenberger, Carol H., Kuan, Elizabeth, Lowe, Jean, Ohls, Robin K. , Beauman, Sandra Sundquist , Thomson, Rebecca A., Watterberg, Kristi L. , Carlson, Martha, Christensen, Mary, Wiggins, Stephanie A., Baker, Shawna, Baserga, Mariana , Bird, Karie, Burnett, Jill, Christensen, Susan, Bledsoe, Laura Cole, Cunningham, Sean D. , Davis, Brandy, Elmont, Jennifer O., Faix, Roger G., Hall, Becky, Jensen, Erika R., Jensen, Jennifer J., Jordan, Jamie, Loertscher, Manndi C., Marchant, Trisha, Maxson, Earl, McGrath, Kandace M., Minton, Stephen D., Morshedzadeh, Galina, Osborne, Karen A., Parry, Dilys M. , Rau, Carrie A., Reich, Brixen A., Schaefer, Susan T., Sheffield, Mark J., Spencer, Cynthia, Steffen, Michael, Stout, Kelly, Stuart, Ashley L., Tice, Katherine, Weaver-Lewis, Kimberlee, Winter, Sarah , Woodbury, Kathryn D., Yoder, Bradley A. , Zanetti, Karen, Chiu, Korinne, Dillard, Robert G., Allred, Deborah Evans, Goldstein, Donald J., Halfond, Raquel, Jackson, Barbara G., O’Shea, T. Michael , Peters, Nancy, Peterson, Carroll, Waldrep, Ellen, Washburn, Lisa K. , Welch, Cherrie D. , Morris, Melissa Whalen, Hounshell, Gail, Kicklighter, Stephen D. , Rhodes-Ryan, Ginger, Abramczyk, Katherine, Agarwal, Prashant , Bajaj, Monika , Bara, Rebecca, Billian, Elizabeth, Chawla, Sanjay , Childs, Kirsten, Jesus, Lilia C. De, Driscoll, D., February, Melissa, Goldston, Laura A., Muran, Geraldine, Natarajan, Girija , Pappas, Athina, Prentice, Jeannette E., Shankaran, Seetha , Sood, Beena G. , White, Diane F., Woldt, Eunice, Butler, Christine G., Cervone, Patricia, Ehrenkranz, Richard A., Gettner, Patricia, Greisman, Sheila, Jacobs, Harris C., Konstantino, Monica, Poulsen, JoAnn, Romano, Elaine, Taft, Janet, Brumbaugh, Jane E. , Das, Abhik , Baack, Michelle L , Ambalavanan, Namasivayam , Carlo, Waldemar A. , Keszler, Martin , Oh, William, Watson, Victoria E. , Lakshminrusimha, Satyan , Hibbs, Anna Maria , Payne, Allison H. , Alexander, Barbara D. , Jobe, Alan Hall , Yolton, Kimberly , Brion, Luc P. , Chen, Lijun , Leon, Maria M. De, Miller, Nancy A., Rosenfeld, Charles R. , Sánchez, Pablo J. , Patel, Ravi M. , Dempsey, Allison G. , Green, Charles E. , Khan, Amir M , Lis, Anna E. , Martin, Karen , Dagle, John M. , Klein, Jonathan M. , Widness, John A. , Calejo, Maria, Fortney, Christine A. , Maitre, Nathalie L. , Nelin, Leif Daniel , Parikh, Nehal A. , Cook, Noah , Kirpalani, Haresh Murli , Mancini, Toni, Schmidt, Barbara Kristina , Vangala, Saritha, Kent, Alison , Sabaratnam, Premini , Bann, Carla , Crawford, Margaret M. , Gantz, Marie G. , Leblond, David, Newman, Jamie E. , Taylor, Heather Lee , Henderson, Christopher, Laughon, Matthew Maxwell , DuPont, Tara L. , Barks, John , Sarkar, Subrata , Parry, D. Melody, Spencer, Cynthia, Steffen, Michael, White, Donna, Johnson, Mary E. , Panaitescu, Bogdan , Williams, Joanne W.
JAMA Network Open | December 8, 2022 | Volume: 5 | Issue: 12 | Pages: e2245826
10.1001/jamanetworkopen.2022.45826
ImportanceLate-onset meningitis (LOM) has been associated with adverse neurodevelopmental outcomes in children born extremely preterm.ObjectiveTo report the incidence of LOM during birth hospitalization and neurodevelopmental outcomes at 18 to 26 months’ corrected age.Design, Setting, and ParticipantsThis cohort study is a secondary analysis of a multicenter prospective cohort of children born at 22 to 26 weeks’ gestation between 2003 and 2017 with follow-up from 2004 to 2021. The study was conducted at 25 Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers.ExposuresCulture-confirmed LOM.Main Outcomes and MeasuresIncidence and microbiology of LOM (2003-2017); lumbar puncture (LP) performance in late-onset sepsis (LOS) evaluations (2011-2017); composite outcome of death or neurodevelopmental impairment (NDI; 2004-2021).ResultsAmong 13 372 infants (median [IQR] gestational age, 25.4 [24.4-26.1] weeks; 6864 [51%] boys), LOM was diagnosed in 167 (1%); LOS without LOM in 4564 (34%); and neither LOS nor LOM in 8641 (65%). The observed incidence of LOM decreased from 2% (95% CI, 1%-3%) in 2003 to 0.4% (95% CI, 0.7%-1.0%) in 2017 (P &lt; .001). LP performance in LOS evaluations decreased from 36% (95% CI, 33%-40%) in 2011 to 24% (95% CI, 21%-27%) in 2017 (P &lt; .001). Among infants with culture-confirmed LOS, LP performance decreased from 58% (95% CI, 51%-65%) to 45% (95% CI, 38%-51%; P = .008). LP performance varied by center among all LOS evaluations (10%-59%, P &lt; .001) and among those with culture-confirmed LOS (23%-79%, P &lt; .001). LOM occurred in the absence of concurrent LOS in 27 of 167 cases (16%). The most common LOM isolates were coagulase-negative Staphylococcus (98 [59%]), Candida albicans (38 [23%]), and Escherichia coli (27 [16%]). Death or NDI occurred in 22 of 46 children (48%) with LOM due to coagulase-negative Staphylococcus, 43 of 67 (64%) due to all other bacterial pathogens, and 26 of 33 (79%) due to fungal pathogens. The adjusted relative risk of death or NDI was increased among children with LOM (aOR, 1.53; 95% CI, 1.04-2.25) and among those with LOS without LOM (aOR, 1.41; 95% CI, 1.29-1.54) compared with children with neither infection.Conclusions and RelevanceIn this cohort study, LP was performed with decreasing frequency, and the observed incidence of LOM also decreased. Both LOM and LOS were associated with increased risk of death or NDI; risk varied by LOM pathogen. The full association of LOM with outcomes of children born extremely preterm may be underestimated by current diagnostic practices.