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

Maya Kohli-Lynch*, Neal J. Russell, Anna C. Seale, Ziyaad Dangor, Cally J. Tann, Carol J. Baker, Linda Bartlett, Clare Cutland, Michael G. Gravett, Paul T. Heath, Margaret Ip, Kirsty Le Doare, Shabir A. Madhi, Craig E. Rubens, Samir K. Saha, Stephanie Schrag, Ajoke Sobanjo-Ter Meulen, Johan Vekemans, Catherine O'Sullivan, Firdose NakwaHechmi Ben Hamouda, Habib Soua, Kyriaki Giorgakoudi, Shamez Ladhani, Theresa Lamagni, Hilary Rattue, Caroline Trotter, Joy E. Lawn

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

89 Citations (Scopus)

Abstract

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Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on the risk of NDi after invasive GBS disease in infants 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.

Original languageEnglish
Pages (from-to)S190-S199
JournalClinical Infectious Diseases
Volume65
DOIs
Publication statusPublished - 2017

Bibliographical note

Funding Information:
Financial support. This supplement was supported by a grant to the London School of Hygiene & Tropical Medicine from the Bill & Melinda Gates Foundation (reference number OPP1131158).

Funding Information:
Potential conflicts of interest. Many contributors to this supplement have received funding for their research from foundations, especially the Bill & Melinda Gates Foundation, and several from Wellcome Trust, Medical Research Council UK, the Thrasher Foundation, the Meningitis Research Foundation, and one individual from the US National Institutes of Health. Members of the Expert Advisory Group received reimbursement for travel expenses to attend working meetings related to this series. A. S.-t. M. works for the Bill & Melinda Gates Foundation. C. J. B. has served as a member of the Presidential Advisory Committee for Seqirus Inc and of the CureVac Inc Scientific Advisory Committee, as well as undertaken consultancy work for Pfizer Inc. C. C. has received institutional compensation from Novartis for conducting GBS studies. P. T. H. has been a consultant to Novartis and Pfizer on GBS vaccines but received no funding for these activities. M. I. has undertaken sponsored research from Pfizer on pneumococcal disease in adults and from Belpharma Eumedica (Belgium) on temocillin antimicrobial susceptibility in Enterobacteriaceae. K. L. D. has received funding by the Bill & Melinda Gates Foundation to work on research on GBS serocorrelates of protection to inform vaccine trials, and travel expenses from Pfizer to attend a meeting on an investigator-led project on GBS. S. A. M. has collaborated on GBS grants funded by GlaxoSmithKline and by Pfizer and received personal fees for being member of its advisory committee; he has also collaborated on a GBS grant funded by Minervax. All other authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Publisher Copyright:
© 2017 The Author.

Keywords

  • Group B Streptococcus
  • disability
  • estimate.
  • impairment
  • infants

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