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Meta-Analysis
. 2017 Nov 6;65(suppl_2):S190-S199.
doi: 10.1093/cid/cix663.

Neurodevelopmental Impairment in Children After Group B Streptococcal Disease Worldwide: Systematic Review and Meta-analyses

Maya Kohli-Lynch  1   2 , Neal J Russell  1   3 , Anna C Seale  1   4 , Ziyaad Dangor  5   6   7 , Cally J Tann  1   8 , Carol J Baker  9 , Linda Bartlett  10 , Clare Cutland  5   6 , Michael G Gravett  11   12 , Paul T Heath  13 , Margaret Ip  14 , Kirsty Le Doare  13   15 , Shabir A Madhi  5   6   16 , Craig E Rubens  1   17 , Samir K Saha  18 , Stephanie Schrag  19 , Ajoke Sobanjo-Ter Meulen  20 , Johan Vekemans  21 , Catherine O'Sullivan  13 , Firdose Nakwa  7 , Hechmi Ben Hamouda  22 , Habib Soua  22 , Kyriaki Giorgakoudi  23 , Shamez Ladhani  24 , Theresa Lamagni  24 , Hilary Rattue  13 , Caroline Trotter  25 , Joy E Lawn  1
Affiliations
Meta-Analysis

Neurodevelopmental Impairment in Children After Group B Streptococcal Disease Worldwide: Systematic Review and Meta-analyses

Maya Kohli-Lynch et al. Clin Infect Dis. .

Abstract

Background: Survivors of infant group B streptococcal (GBS) disease are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified. This is the 10th of 11 articles estimating the burden of GBS disease. Here we aimed to estimate NDI in survivors of infant GBS disease.

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Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on the risk of NDI after invasive GBS disease in infants <90 days of age. We did meta-analyses to derive pooled estimates of the percentage of infants with NDI following GBS meningitis.

Results: We identified 6127 studies, of which 18 met eligibility criteria, all from middle- or high-income contexts. All 18 studies followed up survivors of GBS meningitis; only 5 of these studies also followed up survivors of GBS sepsis and were too few to pool in a meta-analysis. Of meningitis survivors, 32% (95% CI, 25%-38%) had NDI at 18 months of follow-up, including 18% (95% CI, 13%-22%) with moderate to severe NDI.

Conclusions: GBS meningitis is an important risk factor for moderate to severe NDI, affecting around 1 in 5 survivors. However, data are limited, and we were unable to estimate NDI after GBS sepsis. Comparability of studies is difficult due to methodological differences including variability in timing of clinical reviews and assessment tools. Follow-up of clinical cases and standardization of methods are essential to fully quantify the total burden of NDI associated with GBS disease, and inform program priorities.

Keywords: Group B Streptococcus; disability; estimate; impairment; infants.

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Figures

Figure 1.
Figure 1.
Neurodevelopmental impairment after infant group B streptococcal (GBS) disease in the disease schema for GBS, as described by Lawn et al [17]. Abbreviations: GBS, group B Streptococcus; NE, neonatal encephalopathy.
Figure 2.
Figure 2.
Data search and selection. Abbreviation: GBS, group B Streptococcus.
Figure 3.
Figure 3.
Geographic spread of inputs for neurodevelopmental impairment after infant Group B Streptococcus meningitis. Borders of countries/territories in map do not imply any political statement.
Figure 4.
Figure 4.
Infant group B Streptococcus meningitis survivors followed up for a median of ≥18 months with moderate to severe neurodevelopmental impairment. Abbreviations:
Figure 5.
Figure 5.
“Iceberg” of data available on neurodevelopmental outcomes after infant group B streptococcal (GBS) disease.
See this image and copyright information in PMC

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