Neonatal Bacterial Infections Linked to Increased Risk for Epilepsy

Children who experienced neonatal sepsis or meningitis were at higher risk of developing epilepsy in childhood, underscoring the importance of infection prevention in the first week of life.

Children who experience bacterial infections in the first week of life may face a significantly increased risk of developing epilepsy during childhood, according to results published in JAMA Network Open.

Researchers examined long-term risk for epilepsy following early-onset neonatal infections among live-born singleton infants between 1997 and 2013. Children were followed until they turned age 18 or until June 2021. A total of 981,869 near- and full-term children were included in the analysis. Median gestational age was 40 (IQR, 39-41) weeks, and 51% were boys.

Of the participants, 8154 (0.8%) were diagnosed with sepsis, and 152 (<0.1%) were diagnosed with meningitis during the first week of life. Culture-positive infections were confirmed in 257 children with sepsis and 32 with meningitis. The most common pathogens were group B Streptococcus, Staphylococcus aureus, and Escherichia coli.

During the study period, 12,228 (1.2%) children developed epilepsy. Epilepsy onset occurred earlier in children with early infections, at a median age of 6 (IQR, 2-10) years, compared with 7 (IQR, 3-12) years in those without neonatal infection. Incidence of epilepsy was 1.6 per 1000 person-years (PYs) in children with neonatal sepsis, compared with 0.9 per 1000 PYs in those without infection (adjusted hazard ratio [aHR], 1.85; 95% CI, 1.60-2.13).

This nationwide cohort study of near-term and full-term children found an association between early-onset neonatal infection, defined by both diagnoses and bacterial cultures, and childhood epilepsy.

Stratified analyses revealed a stronger association with focal epilepsy (HR, 2.94; 95% CI, 2.30-3.75) than with generalized epilepsy (HR, 1.46; 95% CI, 1.05-2.05). Culture-positive sepsis was also linked to increased epilepsy risk (incidence rate ratio [IRR], 2.70; 95% CI, 1.08-5.56).

Meningitis carried an even greater risk. Children with diagnosed meningitis had an epilepsy IRR of 8.6 per 1000 PYs (IRR, 9.85; 95% CI, 5.52-16.27), while those with culture-confirmed meningitis had a rate of 13.5 per 1000 PYs (IRR, 16.04; 95% CI, 5.21-37.46).

Study limitations include potential diagnostic misclassification, inability to assess pathogen-specific risk, and possible survivor bias underestimating risk.

“This nationwide cohort study of near-term and full-term children found an association between early-onset neonatal infection, defined by both diagnoses and bacterial cultures, and childhood epilepsy,” the study authors concluded.

Disclosures: This research was supported by the Graduate School of Health at Aarhus University, Elsass Foundation, Helsefonden, and Beckett Foundation. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Source: https://www.neurologyadvisor.com/news/neonatal-infections-linked-to-epilepsy-risk/