Parents of infants who survive bacterial meningitis caused by group B Streptococcus might have to live with the effects of the disease on their children long after they're discharged from the hospital.
A new study in the journal Pediatrics finds that even though mortality rates of children infected with GBS meningitis have decreased in the past 25 years, just under half of children who survive the disease will suffer impairment as a result of the disease.
"These bacteria can quickly cause significant damage to the developing infant brain very quickly despite the infant's having received excellent medical care," says Morven S. Edwards, M.D., professor of Pediatrics at Baylor College of Medicine and a co-author on the paper. "This is a potentially devastating illness and we still have a large percentage of infants who have poor outcomes after the infection."
According to the CDC, 25 percent of pregnant women carry GBS. It is routine for these women to receive antibiotics during labor to protect the baby from infection occurring in the first days of life. There is no way to prevent late-onset GBS infections in infants.
"We haven't had recent data on the outcomes of GBS meningitis in over 25 years and the quality of medical care has changed," says Prachi Shah, M.D., a clinical assistant professor at the University of Michigan Medical School Department of Pediatrics and Communicable Diseases, and a senior author on the paper. "We wanted to know, in this era of using antibiotics during birth, whether outcomes have changed for infants who do acquire GBS meningitis. Our study counsels families to be very vigilant about their child if they've had GBS."
The current study shows that, although modern day medicine has improved survival rates, children can still suffer adverse long-term outcomes.
"Despite the fact that mortality has decreased in the last 25 years, survivors of GBS meningitis continue to have substantial long-term morbidity," says Romina Libster, M.D., a physician in the Department of Pediatrics at Vanderbilt University and first author on the paper.
The overall impact of invasive GBS infection in infants is just over 2,000 cases per year in the United States. Among those with bloodstream infection, 10 to 20 percent can also develop meningitis.
The relative importance of GBS as a cause of meningitis has grown in recent years. "GBS is responsible for over 85 percent of bacterial meningitis in children under two months of age," says Edwards. "Vaccination with the newer pneumococcal vaccines has led to tremendous reductions in meningitis from those bacteria."
Using three different and distinctly defined levels to measure functionality, researchers find that 56 percent of children who survived GBS meningitis went on to have age-appropriate (or normal) development, 25 percent had mild-to-moderate impairment and 19 percent had severe impairment.
Signs of mild-to-moderate impairment include continual and significant academic underachievement as well as evidence of mild neurological or functional impairment. Indications of severe impairment include blindness, hearing loss, cerebral palsy, and significantly delayed development.
According to lab data and cranial images at the time of discharge, there are a number of factors that can help predict the likelihood of long-term severe impairment in GBS meningitis survivors, including a failed hearing screening, an abnormal neurologic exam, and abnormal imaging of the head. However, data and imaging cannot as accurately predict children who will have mild impairments, according to the study.
"The more subtle developmental delays suggest that any child who has had GBS meningitis should have ongoing developmental evaluation," says Edwards, "so that problems can be identified early and addressed even before the child actually starts school so that the child has the best chance to fulfill their potential."
The study examined 43 survivors of GBS meningitis between the ages of three and 12 years. Patients were examined physically, neurologically, with hearing and vision screening, and were also assessed using standardized developmental assessments.
Parents were also questioned on perceptions of their child's development. Parents of children who either had normal or severely impaired functionality are able to accurately identify their children as such. However, according to the report, parents of children with mild-to-moderate impairments are less likely to accurately label their child's developmental delay. Because of this, Shah suggests the importance of follow-up evaluations. "Parent self-report is not always an accurate identifier of children who have mild impairment," she says, "which is why survivors of GBS meningitis should receive long-term development surveillance."
According to Edwards, there are two important steps to be taken moving forward. The first is the development of a vaccine for mothers so that the disease can be prevented altogether. "The other," Edwards says, "is just to enhance awareness of the consequences of the infection and of the need for its prevention."
Currently, clinical testing is already underway for a GBS vaccine developed by Novartis Vaccines & Diagnostics.
Additional Authors: Kathryn M. Edwards, M.D., Vanderbilt University Medical Center; Fatma Levent, M.D., Texas Tech University Health Science Center; Marcia A. Rench, R.N., Baylor College of Medicine/Texas Children's Hospital; Luis A. Castagnini, M.D, Blank Children's Hospital; Timothy Cooper, Psy.D., Vanderbilt University Medical Center; Robert C. Sparks, L.P.N./E.M.T.P, Vanderbilt University Medical Center; Carol J. Baker, M.D., Baylor College of Medicine.
Funding: The Max It Out Foundation for Pediatric Research; Vanderbilt University Medical Center, Nashville, TN; Group B Strep Association, Chapel Hill, NC
Disclosure: Dr. M. Edwards is a consultant to and receives consultancy fees and research funding from Novartis Vaccines & Diagnostics.
Reference: Libster et al, "Long Term Outcomes of Group B Streptococcal Meningitis," Pediatrics; originally published online June 11, 2012; DOI: 10.1542/peds.2011-3453
Patients interested in learning more about group B streptococcal meningitis care for pregnant women, newborns and children at the U-M Health System should call 877-475-6688.
The U.S. Centers for Disease Control and Prevention has more information on GBS in pregnancy at http://www.cdc.gov/groupbstrep/index.html
Rebeka Cohan | EurekAlert!
Hot cars can hit deadly temperatures in as little as one hour
24.05.2018 | Arizona State University
3D images of cancer cells in the body: Medical physicists from Halle present new method
16.05.2018 | Martin-Luther-Universität Halle-Wittenberg
The more electronics steer, accelerate and brake cars, the more important it is to protect them against cyber-attacks. That is why 15 partners from industry and academia will work together over the next three years on new approaches to IT security in self-driving cars. The joint project goes by the name Security For Connected, Autonomous Cars (SecForCARs) and has funding of €7.2 million from the German Federal Ministry of Education and Research. Infineon is leading the project.
Vehicles already offer diverse communication interfaces and more and more automated functions, such as distance and lane-keeping assist systems. At the same...
A research team led by physicists at the Technical University of Munich (TUM) has developed molecular nanoswitches that can be toggled between two structurally different states using an applied voltage. They can serve as the basis for a pioneering class of devices that could replace silicon-based components with organic molecules.
The development of new electronic technologies drives the incessant reduction of functional component sizes. In the context of an international collaborative...
At the LASYS 2018, from June 5th to 7th, the Laser Zentrum Hannover e.V. (LZH) will be showcasing processes for the laser material processing of tomorrow in hall 4 at stand 4E75. With blown bomb shells the LZH will present first results of a research project on civil security.
At this year's LASYS, the LZH will exhibit light-based processes such as cutting, welding, ablation and structuring as well as additive manufacturing for...
There are videos on the internet that can make one marvel at technology. For example, a smartphone is casually bent around the arm or a thin-film display is rolled in all directions and with almost every diameter. From the user's point of view, this looks fantastic. From a professional point of view, however, the question arises: Is that already possible?
At Display Week 2018, scientists from the Fraunhofer Institute for Applied Polymer Research IAP will be demonstrating today’s technological possibilities and...
So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics
Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...
25.05.2018 | Event News
02.05.2018 | Event News
13.04.2018 | Event News
25.05.2018 | Event News
25.05.2018 | Machine Engineering
25.05.2018 | Life Sciences