BOSTON — Mortality rates from group B streptococcal
meningitis have declined, but morbidity among survivors remains high, despite
intrapartum prophylaxis, according to Romina Libster, MD.
The aim of the trial was to assess the outcomes of group
B streptococcal meningitis in infants at and near term and examine the factors
associated with the outcomes. Libster, of Vanderbilt University in Nashville,
and colleagues analyzed follow-up data for 42 children diagnosed with GBS
meningitis at term and near-term from 1998 to 2006 at the Texas Children’s
Hospital and Monroe Carell Jr. Children’s Hospital.
Physical and neurological examinations, hearing and
visual screenings and psychological tests were performed on those children who
returned for examination; data were compared with those for children who did
not return for evaluation.
WIAT II and Mullen Scales of Early Learning were used.
To define neurological sequelae severity, Libster and colleagues used the
- Normal: WIAT II standard scores, Mullen T scores, or cognitive
standard scores +/- 1 standard deviation (SD) from the mean and no neurological
or functional impairment.
- Mild to moderate impairment: WIAT II scores 1-2 SD below the mean, or
>15 point split between subtest categories; Mullen T scores 1-2 SD below the
mean in one or more domains or cognitive T scores between 1-2 standard
deviations below the mean, or evidence of mild or moderate neurological or
- Severe impairment: WIAT II and Mullen T scores >2 SD below the
mean in 1 or more areas of achievement or domains, or evidence of severe
neurological or functional impairment.
Approximately one-half of patients had some impairment:
30% had mild to moderate sequelae and about 20% of patients had severe sequelae
or late death, she told Infectious Diseases in Children. Factors associated
with death or severe impairment upon admission included: lethargy, respiratory
distress, coma or semicoma, seizures, bulging fontanel, leukopenia, acidosis,
CFS proteins >300 mg/dL, CSF glucose <20 mg/dL, need for ventilatory
support or need for pressor support.
Additionally, children who failed the hearing screening,
had an abnormal neurological exam or had abnormal brain imaging were also at
increased risk for death or abnormal developmental examinations at discharge.
“The important thing here is that we already know
these patients are going to have impairment at discharge, but what happened
with those children that are in the mild to moderate group? Why do they have
some impairments that are not evident when they go to follow-up? In these
children, when they come to follow-up, we should ask for the psychological and
developmental evaluation to try to optimize their skills; this is the most
important thing.” — by Stacey L. Fisher
Disclosure: Dr. Libster reports no relevant financial
For more information:
- Libster R. #946. Presented at: IDSA 49th Annual
Meeting; Oct. 20-23, 2011; Boston.