Long-term outcomes of group B streptococcal meningitis.
OBJECTIVE
Group B Streptococcus (GBS) is the leading cause of meningitis in young infants. We evaluated long-term outcomes among GBS meningitis survivors. We hypothesized that despite reduced mortality, GBS meningitis would remain a significant cause of morbidity among GBS survivors.


METHODS
Ninety term and near-term infants diagnosed with GBS meningitis from 1998 through 2006 were identified from 2 children's hospitals. Five died acutely, and 5 died at 6 months to 3 years of age. Forty-three survivors (54%; mean age 6.8, range 3-12 years) were consented for evaluation and underwent physical and neurologic examinations, hearing and vision screening, and standardized developmental assessments. Associations among presenting features, laboratory parameters, neurologic status at hospital discharge, and later developmental outcomes were explored by using descriptive statistics and logistic regression.


RESULTS
Twenty-four of 43 (56%) children evaluated demonstrated age-appropriate development, 11 (25%) had mild-to-moderate impairment, and 8 (19%) had severe impairment. Admission features associated with death after hospital discharge or severe impairment included lethargy (P = .003), respiratory distress (P = .022), coma or semicoma (P = .022), seizures (P = .015), bulging fontanel (P = .034), leukopenia (P = .026), acidosis (P = .024), cerebrospinal fluid protein >300 mg/dL (P = .006), cerebrospinal fluid glucose <20 mg/dL (P = .026), and need for ventilator (P = .002) or pressor support (P < .001). Features at discharge associated with late death or severe impairment included failed hearing screen (P = .004), abnormal neurologic examination (P < .001), and abnormal end of therapy brain imaging (P = .038).


CONCLUSIONS
Survivors of GBS meningitis continue to have substantial long-term morbidity, highlighting the need for ongoing developmental follow-up and prevention strategies such as maternal immunization.
Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Romina
R
Libster
Kathryn M
KM
Edwards
Fatma
F
Levent
Morven S
MS
Edwards
Marcia A
MA
Rench
Luis A
LA
Castagnini
Timothy
T
Cooper
Robert C
RC
Sparks
Carol J
CJ
Baker
Prachi E
PE
Shah
D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006311:Hearing Disorders / Q000175:diagnosis / Q000209:etiology*; D006320:Hearing Tests; D006801:Humans; D007223:Infant; D007859:Learning Disabilities / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000401:mortality; D015999:Multivariate Analysis; D009460:Neurologic Examination; D011581:Psychological Tests; D013290:Streptococcal Infections / Q000150:complications* / Q000401:mortality; D013292:Streptococcus agalactiae; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology*; D015351:Vision Screening