757 - Association between cumulative febrile, respiratory and diarrheal illness in the first year of life and neurodevelopmental and growth outcomes among a cohort of children in rural Guatemala.

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Presenting Author(s)

Daniel Olson

Associate Professor
CU School of Medicine
Denver, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

ML

Molly Lamb

Assistant Professor
Colorado School of Public Health
Aurora, Colorado
Disclosure: BioFire (Grant/Research Support)
AC

Amy Connery

Assistant Professor
University of Colorado
Denver, CO
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DB

Desiree Bauer

Mrs.
Center for Human Development, Fundacion para la Salud de los Guatemaltecos, Retalhuleu, Guatemala
Denver, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
aP

alejandra Paniagua-avila

Investigator
Fundacion para la Salud Integral de los Guatemaltecos
Guatemala City, Sacatepequez, Guatemala
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KC

Kathryn L. Colborn

PhD
University of Colorado
Aurora, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MN

Muktha Natrajan

Investigator
Emory University Vaccine Center
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JW

Jesse Waggoner

Assistant Professor
Emory University School of Medicine
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Evan J. Anderson

Professor
Emory University School of Medicine
Atlanta, Georgia
Disclosure: Sanofi Pasteur (Scientific Research Study Investigator)
MC

Mirella Calvimontes

Investigator
Fundacion para la Salud Integral de los Guatemaltecos
Aurora, CO
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GB

Guillermo Antonio Bolanos

Clinical Director
Fundacion para la Salud Integral de los Guatemaltecos
Retalhuleu, Retalhuleu, Guatemala
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AH

Andrea Holliday

Data Manager/Protocol Monitor
EMMES Corporation
Rockville, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
FM

Flor Munoz

Associate Professor of Pediatrics
Baylor College of Medicine
Houston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Flor M. Munoz

Associate Professor of Pediatrics
Baylor College of Medicine
Houston, TX
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EA

Edwin J. Asturias

Professor
CU School of Medicine
Aurora, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Recurrent infections are associated with neurodevelopmental (ND) delay in infants, but the primary drivers are poorly understood. Leveraging an infant cohort from rural Guatemala designed to evaluate the effects of post-natal Zika virus on ND (DMID 16-0057), we evaluated the association between cumulative illness and ND delay and stunting.

Methods: Infants enrolled at 0-3 months of age underwent weekly at-home surveillance for caregiver-reported syndromic illness, including cough, fever and vomiting/diarrhea for a 12-month period. Anthropometric assessments and ND testing by Guatemalan psychologists using the Mullen Scales of Early Learning (MSEL) were perforrmed at 12-15 months of age. Multivariable generalized linear regression models were used to test associations between syndromic illness in infancy, 12-15-month MSEL Early Learning Composite (ELC) Score, and stunting (height-for-age < -2 SD) at 12-15 months.

Results: The cohort (n=425) had a mean enrollment age of 1.3 months; 202 (48%) were female, 387 (91%) self-reported a literate mother, and 301 (71%) were breastfeeding at study completion. Infants had reported illness for a median of 16 weeks during the surveillance period; cough was reported most frequently (median=11 weeks, range=0-37 weeks). Lower maternal education (p=0.007) and literacy (p=0.002) as well as infant age (p=0.007) and male gender (p=0.004) were associated with MSEL ELC Score <85 (-1 SD). After adjusting for gender, breastfeeding, age, and maternal literacy, the cumulative number of weeks with reported cough (p=0.0009), fever (p=0.0001), or any syndromic illness (p=0.0007) were associated with decreased 12-month MSEL ECL Score; there was no association with diarrhea/vomiting (p=0.36). There was no association between caregiver-reported syndromic illnesses (any type) and stunting at final study visit.

Conclusion: In a cohort of Guatemalan infants, cumulative fever and cough episodes were significantly associated with lower MSEL ELC Score, whereas there was no association with diarrhea/vomiting. In this low-resource community, these findings highlight the potential negative ND consequences of febrile illness and persistent cough in the first year of life. NIAID Contract HHSN272201300015I Task Order HHSN27200013 (Co-PIs: FMM and EJA).