Early-onset neonatal infection and school performance: a Danish nationwide population-based cohort study

Mads Andersen; Niels Bjerregård Matthiesen; May Murra; Stine Yde Nielsen; Tine Brink Henriksen

doi:10.1016/j.cmi.2024.12.029

Early-onset neonatal infection and school performance: a Danish nationwide population-based cohort study

Mads Andersen^*, Niels Bjerregård Matthiesen, May Murra, Stine Yde Nielsen, Tine Brink Henriksen

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

Objectives: We aimed to study the association between early-onset neonatal infection in near-term and term children and school performance based on mandatory tests in reading and mathematics. Methods: We conducted a nationwide register-based cohort study including all Danish near-term and term singletons born from 1997 to 2009. Early-onset infection was defined as an invasive bacterial infection during the first week of life. Infections were categorized into diagnosed sepsis or meningitis, and culture-positive sepsis or meningitis verified by bacteria cultured from blood or cerebrospinal fluid. Multivariable mixed model linear regression was used to estimate mean differences in test scores, expressed as standard deviation scores (SDSs) with 95% CI. Results: Among 638 402 children, 2 362 046 test scores were available from 9 to 15 years of age. A total of 5347 children were diagnosed with sepsis and 73 with meningitis, while 135 also had culture-positive sepsis and 20 had culture-positive meningitis. Diagnosed sepsis was associated with lower test scores with mean differences in reading of –0.08 SDS (95% CI: –0.10 to –0.05) and mathematics of –0.08 SDS (95% CI: –0.10 to –0.05). Diagnosed meningitis was associated with even lower test scores with mean differences in reading of –0.22 SDS (95% CI: –0.43 to 0.00) and mathematics of –0.31 SDS (95% CI: –0.55 to –0.07). These findings remained consistent even in sibling-matched analyses. Similar results were also found when only culture-positive infections were compared with the reference population. Sepsis caused by Escherichia coli showed the largest reduction in test scores, whereas group B Streptococcus appeared not to affect point estimates. Discussion: Early-onset sepsis was associated with modest reductions in test scores. This may be insignificant for the individual but could be important on a public health level. Early-onset meningitis was associated with more substantial reductions, emphasizing the severity of this condition even in children able to attend public school.

Originalsprog	Engelsk
Tidsskrift	Clinical Microbiology and Infection
Vol/bind	31
Nummer	3
Sider (fra-til)	389-395
Antal sider	7
ISSN	1198-743X
DOI	https://doi.org/10.1016/j.cmi.2024.12.029
Status	Udgivet - mar. 2025

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abstract = "Objectives: We aimed to study the association between early-onset neonatal infection in near-term and term children and school performance based on mandatory tests in reading and mathematics. Methods: We conducted a nationwide register-based cohort study including all Danish near-term and term singletons born from 1997 to 2009. Early-onset infection was defined as an invasive bacterial infection during the first week of life. Infections were categorized into diagnosed sepsis or meningitis, and culture-positive sepsis or meningitis verified by bacteria cultured from blood or cerebrospinal fluid. Multivariable mixed model linear regression was used to estimate mean differences in test scores, expressed as standard deviation scores (SDSs) with 95% CI. Results: Among 638 402 children, 2 362 046 test scores were available from 9 to 15 years of age. A total of 5347 children were diagnosed with sepsis and 73 with meningitis, while 135 also had culture-positive sepsis and 20 had culture-positive meningitis. Diagnosed sepsis was associated with lower test scores with mean differences in reading of –0.08 SDS (95% CI: –0.10 to –0.05) and mathematics of –0.08 SDS (95% CI: –0.10 to –0.05). Diagnosed meningitis was associated with even lower test scores with mean differences in reading of –0.22 SDS (95% CI: –0.43 to 0.00) and mathematics of –0.31 SDS (95% CI: –0.55 to –0.07). These findings remained consistent even in sibling-matched analyses. Similar results were also found when only culture-positive infections were compared with the reference population. Sepsis caused by Escherichia coli showed the largest reduction in test scores, whereas group B Streptococcus appeared not to affect point estimates. Discussion: Early-onset sepsis was associated with modest reductions in test scores. This may be insignificant for the individual but could be important on a public health level. Early-onset meningitis was associated with more substantial reductions, emphasizing the severity of this condition even in children able to attend public school.",

keywords = "Cognitive function, Early-onset infection, Neonatal meningitis, Neonatal sepsis, School performance",

author = "Mads Andersen and Matthiesen, {Niels Bjerreg{\aa}rd} and May Murra and Nielsen, {Stine Yde} and Henriksen, {Tine Brink}",

note = "Publisher Copyright: {\textcopyright} 2024 European Society of Clinical Microbiology and Infectious Diseases",

year = "2025",

month = mar,

doi = "10.1016/j.cmi.2024.12.029",

language = "English",

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Early-onset neonatal infection and school performance: a Danish nationwide population-based cohort study. / Andersen, Mads ; Matthiesen, Niels Bjerregård ; Murra, May et al.
I: Clinical Microbiology and Infection, Bind 31, Nr. 3, 03.2025, s. 389-395.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Early-onset neonatal infection and school performance

T2 - a Danish nationwide population-based cohort study

AU - Andersen, Mads

AU - Matthiesen, Niels Bjerregård

AU - Murra, May

AU - Nielsen, Stine Yde

AU - Henriksen, Tine Brink

PY - 2025/3

Y1 - 2025/3

N2 - Objectives: We aimed to study the association between early-onset neonatal infection in near-term and term children and school performance based on mandatory tests in reading and mathematics. Methods: We conducted a nationwide register-based cohort study including all Danish near-term and term singletons born from 1997 to 2009. Early-onset infection was defined as an invasive bacterial infection during the first week of life. Infections were categorized into diagnosed sepsis or meningitis, and culture-positive sepsis or meningitis verified by bacteria cultured from blood or cerebrospinal fluid. Multivariable mixed model linear regression was used to estimate mean differences in test scores, expressed as standard deviation scores (SDSs) with 95% CI. Results: Among 638 402 children, 2 362 046 test scores were available from 9 to 15 years of age. A total of 5347 children were diagnosed with sepsis and 73 with meningitis, while 135 also had culture-positive sepsis and 20 had culture-positive meningitis. Diagnosed sepsis was associated with lower test scores with mean differences in reading of –0.08 SDS (95% CI: –0.10 to –0.05) and mathematics of –0.08 SDS (95% CI: –0.10 to –0.05). Diagnosed meningitis was associated with even lower test scores with mean differences in reading of –0.22 SDS (95% CI: –0.43 to 0.00) and mathematics of –0.31 SDS (95% CI: –0.55 to –0.07). These findings remained consistent even in sibling-matched analyses. Similar results were also found when only culture-positive infections were compared with the reference population. Sepsis caused by Escherichia coli showed the largest reduction in test scores, whereas group B Streptococcus appeared not to affect point estimates. Discussion: Early-onset sepsis was associated with modest reductions in test scores. This may be insignificant for the individual but could be important on a public health level. Early-onset meningitis was associated with more substantial reductions, emphasizing the severity of this condition even in children able to attend public school.

AB - Objectives: We aimed to study the association between early-onset neonatal infection in near-term and term children and school performance based on mandatory tests in reading and mathematics. Methods: We conducted a nationwide register-based cohort study including all Danish near-term and term singletons born from 1997 to 2009. Early-onset infection was defined as an invasive bacterial infection during the first week of life. Infections were categorized into diagnosed sepsis or meningitis, and culture-positive sepsis or meningitis verified by bacteria cultured from blood or cerebrospinal fluid. Multivariable mixed model linear regression was used to estimate mean differences in test scores, expressed as standard deviation scores (SDSs) with 95% CI. Results: Among 638 402 children, 2 362 046 test scores were available from 9 to 15 years of age. A total of 5347 children were diagnosed with sepsis and 73 with meningitis, while 135 also had culture-positive sepsis and 20 had culture-positive meningitis. Diagnosed sepsis was associated with lower test scores with mean differences in reading of –0.08 SDS (95% CI: –0.10 to –0.05) and mathematics of –0.08 SDS (95% CI: –0.10 to –0.05). Diagnosed meningitis was associated with even lower test scores with mean differences in reading of –0.22 SDS (95% CI: –0.43 to 0.00) and mathematics of –0.31 SDS (95% CI: –0.55 to –0.07). These findings remained consistent even in sibling-matched analyses. Similar results were also found when only culture-positive infections were compared with the reference population. Sepsis caused by Escherichia coli showed the largest reduction in test scores, whereas group B Streptococcus appeared not to affect point estimates. Discussion: Early-onset sepsis was associated with modest reductions in test scores. This may be insignificant for the individual but could be important on a public health level. Early-onset meningitis was associated with more substantial reductions, emphasizing the severity of this condition even in children able to attend public school.

KW - Cognitive function

KW - Early-onset infection

KW - Neonatal meningitis

KW - Neonatal sepsis

KW - School performance

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U2 - 10.1016/j.cmi.2024.12.029

DO - 10.1016/j.cmi.2024.12.029

M3 - Journal article

C2 - 39725076

AN - SCOPUS:85214848158

SN - 1198-743X

VL - 31

SP - 389

EP - 395

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

IS - 3

ER -

Early-onset neonatal infection and school performance: a Danish nationwide population-based cohort study

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