Abstract:
Neonatal sepsis remains a critical public health concern in low- and middle-income countries such as Nepal, where limited neonatal care resources and delayed diagnosis contribute to significant morbidity. Although survival rates have gradually increased with improvements in neonatal intensive care, the long-term neurodevelopmental consequences among survivors remain insufficiently explored. This study aims to assess early neurodevelopmental outcomes in infants with documented neonatal sepsis and emphasize the need for structured follow-up and early intervention to reduce developmental impairments.
This ongoing prospective cohort study includes neonates diagnosed with both culture-positive and culture-negative sepsis admitted to two level III neonatal intensive care units (NICUs) in Nepal. A total of 395 infants have been enrolled, with 241 completing the 6-month follow-up and 157 completing assessments at both 6 months and 1 year. Data collection includes socio-demographic characteristics, maternal education, prenatal factors such as maternal infections, intrauterine growth restriction (IUGR), and fetal distress, as well as neonatal clinical variables including assisted ventilation and complications. Neurodevelopmental evaluations were performed using the Developmental Assessment Scale for Indian Infants (DASII), validated by the Nepal Health Research Council (NHRC).
At six months, 16.6% of infants demonstrated motor delay, 14% exhibited mental delay, and 30.6% showed overall developmental delay. By one year, developmental delays decreased to 13.4% for motor, 5.1% for mental, and 18.5% overall. Identified protective factors included prenatal vitamin supplementation (AOR: 0.186), culture-negative sepsis (AOR: 0.137), and gestational age ≥37 weeks (AOR: 0.116). Pregnancy-induced hypertension emerged as a significant risk factor, increasing the likelihood of motor delay at one year (AOR: 3.125).
These findings highlight that a substantial proportion of neonatal sepsis survivors experience early neurodevelopmental delays, particularly within the first six months of life. Although improvements are observed by one year, the presence of persistent delays reinforces the need for comprehensive developmental monitoring, timely screening, and structured interventions in resource-limited settings. Tailored follow-up programs, caregiver education, and integrated early childhood services can significantly enhance developmental outcomes for this vulnerable population.
Keywords: Neonatal Sepsis; Neurodevelopment; Developmental Delay; Infant Health; Low- and Middle-Income Countries (LMICs)
