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Meta-Analysis
. 2017 Nov 6;65(suppl_2):S173-S189.
doi: 10.1093/cid/cix662.

Neonatal Encephalopathy With Group B Streptococcal Disease Worldwide: Systematic Review, Investigator Group Datasets, and Meta-analysis

Cally J Tann  1   2 , Kathryn A Martinello  2   3 , Samantha Sadoo  1   2 , Joy E Lawn  1 , Anna C Seale  1   4 , Maira Vega-Poblete  2   5 , Neal J Russell  1   6 , Carol J Baker  7 , Linda Bartlett  8 , Clare Cutland  9 , Michael G Gravett  10   11 , Margaret Ip  12 , Kirsty Le Doare  13   14 , Shabir A Madhi  9   15 , Craig E Rubens  10   16 , Samir K Saha  17 , Stephanie Schrag  18 , Ajoke Sobanjo-Ter Meulen  19 , Johan Vekemans  20 , Paul T Heath  14 ; GBS Neonatal Encephalopathy Investigator Group
Collaborators, Affiliations
Meta-Analysis

Neonatal Encephalopathy With Group B Streptococcal Disease Worldwide: Systematic Review, Investigator Group Datasets, and Meta-analysis

Cally J Tann et al. Clin Infect Dis. .

Abstract

Background: Neonatal encephalopathy (NE) is a leading cause of child mortality and longer-term impairment. Infection can sensitize the newborn brain to injury; however, the role of group B streptococcal (GBS) disease has not been reviewed. This paper is the ninth in an 11-article series estimating the burden of GBS disease; here we aim to assess the proportion of GBS in NE cases.

Methods: We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups reporting GBS-associated NE. Meta-analyses estimated the proportion of GBS disease in NE and mortality risk. UK population-level data estimated the incidence of GBS-associated NE.

Results: Four published and 25 unpublished datasets were identified from 13 countries (N = 10436). The proportion of NE associated with GBS was 0.58% (95% confidence interval [CI], 0.18%-.98%). Mortality was significantly increased in GBS-associated NE vs NE alone (risk ratio, 2.07 [95% CI, 1.47-2.91]). This equates to a UK incidence of GBS-associated NE of 0.019 per 1000 live births.

Conclusions: The consistent increased proportion of GBS disease in NE and significant increased risk of mortality provides evidence that GBS infection contributes to NE. Increased information regarding this and other organisms is important to inform interventions, especially in low- and middle-resource contexts.

Keywords: group B Streptococcus; hypoxic-ischemic encephalopathy; neonatal encephalopathy; newborn; therapeutic hypothermia.

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Figures

Figure 1.
Figure 1.
Neonatal encephalopathy (NE) is part of the compartmental model to estimate the burden of group B streptococcal (GBS) disease, as described by Lawn et al [54].
Figure 2.
Figure 2.
Search strategy and process of study selection regarding group B streptococcal disease among cases of neonatal encephalopathy. Abbreviations: GBS, group B Streptococcus; HIE, hypoxic-ischemic encephalopathy; NE, neonatal encephalopathy.
Figure 3.
Figure 3.
Geographic distribution of data inputs on neonatal encephalopathy with data on group B streptococcal disease. Borders of countries/territories in map do not imply any political statement.
Figure 4.
Figure 4.
Meta-analysis of the proportion of group B Streptococcus identified from a sterile site among infants with neonatal encephalopathy assumed to be due to hypoxic-ischemic encephalopathy, in infants meeting criteria for therapeutic hypothermia. Abbreviations: CI, confidence interval; CNN, Canadian Neonatal Network; ES, estimate; GBS, group B Streptococcus; NDAU, Neonatal Data Analysis Unit.
See this image and copyright information in PMC

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