South Indian Children's Neurodevelopmental Outcomes After Group B Streptococcus Invasive Disease: A Matched-Cohort Study

Abstract

Background: This study is part of a multicountry matched-cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI) of children exposed to invasive group B Streptococcus (iGBS). The specific objective of this paper is to compare NDI across domains of iGBS survivors with a matched non iGBS group in our population.

Methods: Survivors of iGBS in a South Indian hospital were identified and recruited between January 2020 and April 2021. Cases were compared with age- and gender-matched non iGBS children. Participants were assessed using Bayley Scales of Infant and Toddler Development-3rd edition (BSID-III), Wechsler Preschool and Primary Scale of Intelligence-4th edition (WPPSI-IV), Wechsler Intelligence Scale for Children-5th edition (WISC-V), Child Behavior Checklist (CBCL), and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2), depending on age.

Results: Our cohort comprised 35 GBS-exposed and 65 matched non iGBS children, aged 1-14 years. The iGBS-exposed group had 17 (48.6%) children with impairment in ≥1 domain compared to 25 (38%) in the non iGBS group (unadjusted OR, 1.51; 95% CI, .65-3.46), 9 (26%) children with "multi-domain impairment" compared to 10 (15.4%) in the non iGBS group (unadjusted OR, 1.90; 95% CI, .69-5.24), and 1 (2.9%) child with moderate to severe impairment compared to 3 (4.6%) in the non iGBS group (unadjusted OR, .60; 95% CI, .06-6.07). In the iGBS group, more children had motor impairments compared with the non iGBS group (unadjusted OR, 10.7; 95% CI, 1.19-95.69; P = .034).

Conclusions: Children with iGBS seem at higher risk of developing motor impairments compared with a non iGBS group.

Keywords: India; group B Streptococcus invasive disease; neurodevelopmental impairment; neurodevelopmental outcomes.

Figure 1.

Map of the multicountry iGBS long-term follow-up studies, showing details of the India site. India was 1 of 5 low- and middle-income countries who participated in the study. Abbreviations: GBS, group B Streptococcus; iGBS, invasive group B Streptococcus.

Figure 2.

Participant flow of iGBS cases and non iGBS children recruited. Out of 79 iGBS survivors contacted, 35 consented for participation and completed the assessment. Out of 158 matched non iGBS children contacted for participation, 65 children consented and completed neurodevelopmental, vision and hearing assessments. Abbreviations: GBS, group B Streptococcus; iGBS, invasive group B Streptococcus.

Figure 3.

Results of NDI by domain for iGBS and non iGBS children. The figure describes impairment severity by domain in the iGBS and non iGBS group. Unadjusted OR values are reported for no impairment versus impairment. Abbreviations: CI, confidence interval; GBS, group B Streptococcus; iGBS, invasive group B Streptococcus; NDI, neurodevelopmental impairment; OR, odds ratio.