Diarrheal Pathogens Associated with Growth and Neurodevelopment.

BACKGROUND Diarrheal pathogens have been associated with linear growth deficits. The effect of diarrheal pathogens on growth is likely due to inflammation which also adversely affects neurodevelopment. We hypothesized that diarrheagenic pathogens would be negatively associated with both growth and neurodevelopment. METHODS We conducted a longitudinal birth cohort study of 250 children with diarrheal surveillance and measured pathogen burden in diarrheal samples using quantitative PCR. Pathogen attributable fraction estimates (AFe) of diarrhea over the first two years of life, corrected for socioeconomic variables, were used to predict both growth and scores on the Bayley III Scales of Infant and Toddler Development. RESULTS 180 children were analyzed for growth and 162 for neurodevelopmental outcomes. Rotavirus, Campylobacter, and Shigella were the leading causes of diarrhea in year 1 while Shigella, Campylobacter, and ST-ETEC were the leading causes in year 2. Norovirus was the only pathogen associated with LAZ at 24 months and was positively associated (RC 0.42, CI 0.04, 0.80). Norovirus (RC 2.46, CI 0.05 - 4.87) was also positively associated with cognitive scores while sapovirus (RC -2.64, CI -4.80 - -0.48) and Typical EPEC (RC -4.14, CI -8.02 - -0.27) were inversely associated. No pathogens were associated with language or motor scores. Significant maternal, socioeconomic, and perinatal predictors were identified for both growth and neurodevelopment. CONCLUSION Maternal, prenatal, and socioeconomic factors were common predictors of growth and neurodevelopment. Only a limited number of diarrheal pathogens were associated with these outcomes.