OUTCOME OF GROUP B STREPTOCOCCAL MENINGITIS

Baylor College Of Medicine, Houston TX

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Abstract

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Despite implementation of intrapartum antibiotic prophylaxis (IAP) and resultant decrease in total cases of neonatal group B streptococcal (GBS) disease, term infants who acquire GBS meningitis remain at risk for a fatal outcome or debilitating longterm sequelae. Review of records of the Infectious Disease service at TCH for the years 1998-2006 has identified 48 infants who survived an episode of GBS meningitis. Parents/guardians of these subjects, now 2-10 years of age, will be invited to participate in a single outpatient visit at which interval history and physical examination, hearing screening by puretone audiometry, vision screening with an age-appropriate eye chart and developmental screening appropriate for age will be conducted. As appropriate, medical and school records will be accessed after the visit. Children will be categorized as functioning normally, neurologically devastated or having mild or moderate sequelae that warrant further evaluation. Findings will be discussed with the parent/guardian. Those who are found to have sequelae or abnormalities will be referred to an appropriate specialist for further care as indicated. HYPOTHESIS: We hypothesize that, despite implementation of IAP and resultant decrease in total cases of neonatal GBS disease, term infants who survive GBS meningitis have debilitating longterm sequelae. SPECIFIC AIMS-To evaluate individual children s outcomes following GBS meningitis in infancy;To summarize these outcomes for the evaluated group of children Meningitis caused by GBS is one of the most serious infections of neonates and young infants. It is a significant cause of morbidity and mortality. GBS meningitis more frequently occurs in late onset disease (estimated 35% of the cases), but also is a clinical manifestation of disease in 5 to 10 % of early-onset cases. Survivors of meningitis are at high risk for neurologic sequelae and lifelong impairment as a result of the infectious insult to their developing brains. Prior to implementation of IAP, 21 to 30% of affected infants had a fatal outcome and 25 to 50% of those surviving the acute illness had longterm sequelae as the result of infection (6). Vigorous supportive care and early institution of appropriate antibiotic therapy have resulted in reduced mortality, but there is little outcome data for GBS meningitis in the IAP era, particularly for infants of term gestation.