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To the Editor: Dr Stoll and colleagues¹ confirm an association between adverse neurodevelopmental outcome and infection in extremely low-birth-weight (ELBW) infants. Of note is that there was a 30% increase in both neurodevelopmental impairment and poor head growth in infants with coagulase-negative staphylococcal sepsis and those with culture-negative clinical infection. These 2 groups represented about two thirds of all episodes of proven or suspected infection, so it is important that they are included in possible therapeutic trials of anti-inflammatory agents.² We would like to know what proportion of culture-negative clinical infection was attributed to pneumonia. It would also be valuable to know whether necrotizing enterocolitis (NEC) alone (without prior, concurrent, or subsequently proven sepsis) was associated with adverse neurodevelopmental outcome.

William Tarnow-Mordi, MRCP(UK), FRCPCH
williamtm@med.usyd.edu.au

David Isaacs, MD, FRCP; David Henderson Smart, PhD, FRACP
University of Sydney
Sydney, Australia

Ben Stenson, MD, FRCPCH
University of Edinburgh
Edinburgh, Scotland

Khalid Haque, MD, FRCPCH
St Helier Hospital
Carshalton, England

1. Stoll BJ, Hansen NI, Adams-Chapman I, et al, National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004;292:2357-2365. FREE FULL TEXT 2. Mohan PV, Tarnow-Mordi W, Stenson B, et al. Can polyclonal intravenous immunoglobulin limit cytokine mediated cerebral damage and chronic lung disease in preterm infants? Arch Dis Child Fetal Neonatal Ed. 2004;89:F5-F8. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293:932.

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