title: Long-term outcomes of infective encephalitis in children: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The long-term outcomes of childhood infective encephalitis are variable and not well quantified. We aimed to systematically review the literature and undertake meta-analyses on predetermined outcomes to address this knowledge gap and identify areas for future research.
  
  
  METHODS
  We searched electronic databases, performed complementary reviews of references of fully extracted articles, and made contact with experts on infective encephalitis. Articles published up until April 2016 were selected for screening.
  
  
  RESULTS
  We evaluated sequelae of 1018 survivors of childhood infective encephalitis (934 with complete follow-up) from 16 studies. Mean age during acute encephalitis episodes was 5 years 3.6 months (range 1.2mo-17y), 57.6% were male (500/868), and mean follow-up period was 4 years 1.2 months (range 1-12y). Incomplete recovery was reported in 312 children (42.0%; 95% confidence interval [CI] 31.6-53.1% in pooled estimate). Among the other sequelae, developmental delay, abnormal behaviour, motor impairment, and seizures were reported among 35.0% (95% CI 10.0-65.0%), 18.0% (95% CI 8.0-31.0%), 17.0% (95% CI 10.0-26.0%), and 10.0% (95% CI 6.0-14.0%) respectively.
  
  
  CONCLUSIONS
  Almost half of childhood infective encephalitis survivors report incomplete recovery in the long-term; most commonly developmental delay, behavioural abnormality, and neurological impairments (i.e. seizure). Well designed, large-scale prospective studies are needed to better quantify neurodevelopmental sequelae among childhood encephalitis survivors.
authors.affiliation: Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. gulam.khandaker@health.nsw.gov.au.|National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW, Australia. gulam.khandaker@health.nsw.gov.au.|Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia. gulam.khandaker@health.nsw.gov.au.
authors.forename: Gulam
authors.initials: G
authors.lastname: Khandaker
authors.affiliation: Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Jung
authors.affiliation: Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia.|Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Philip N
authors.initials: PN
authors.lastname: Britton
authors.affiliation: National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: King
authors.affiliation: National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW, Australia.|Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Yin
authors.affiliation: Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia.|Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology / Q000209:etiology*; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D000069544:Infectious Encephalitis / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D008297:Male; D009069:Movement Disorders / Q000453:epidemiology / Q000209:etiology*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D012640:Seizures / Q000453:epidemiology / Q000209:etiology*