Introduction Serious neonatal infections including pneumonia, sepsis and meningitis account for a third of neonatal deaths around the world. However data on neuro-cognitive impairment after neonatal infection, particularly following clinical diagnosis of possible serious bacterial infection (pSBI) used to guide empiric treatment are lacking.

Methodology This prospective study included 102/196 children born in a rural hospital in Kenya who survived neonatal pSBI (excluding those with confirmed meningitis) and 94/196 well neonates born in the same hospital. Children had neurodevelopmental assessments (incl. vision, hearing, motor) at between 18 to 36 months. A culturally appropriate neurodevelopmental assessment tool, Kilifi developmental inventory (KDI) was utilised in this study. Risks and differences in impairment were assessed using multivariable logistic and linear regressions respectively, adjusting for age, birth weight, gestational age, clinical diagnosis of HIE and bacteraemia.

Results The children who had neonatal pSBI had a higher risk of developing neurodevelopmental impairment (18/102(17.6%) vs 5/94 (5.3%); Odds Ratio (OR) 1.78, 95%confidence interval (CI) 1.60–1.99) compared to those without pSBI. Speech and language (13/102 (12.7%) vs 3/94 (3.2%); OR 1.41, 95% CI 1.29–1.56) and neuro-motor domains (11/102 (10.8%) vs 4/94 (4.3%); OR 1.38, 95% CI 1.22–1.58) were most commonly affected domains. Psychomotor scores from KDI tool were also significantly higher for those unexposed to pSBI for total scores compared to those exposed.

Conclusion Neonatal pSBI (excluding cases of confirmed meningitis) caused significant neurodevelopmental impairment in children after adjusting for confirmed bacteraemia. This has important implications for improving prevention, supporting effective neonatal care and managing the long-term consequences of neonatal infection in resource-poor settings.