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Neurodevelopmental impairment in children after Group B Streptococcal Disease worldwide: Systematic Review and meta-analyses

Kohli-Lynch, M., Russell, N.j., Seale, A. C., Dangor, Z., Tann, C. J., Baker, C. J., Bartlett, L., Cutland, C., Gravett, M. G., Heath, P. T., Ip, M., Le Doare, K., Madhi, S. A., Rubens, C. E., Saha, S. K., Schrag, S., Sobanjo-ter Meulen, A., Vekemans, J., O'Sullivan, C., Nakwa, F., Ben Hamouda, H., Soua, H., Giorgakoudi, K., Ladhani, S., Lamagni, T., Rattue, H., Trotter, C. and Lawn, J. E. (2017). Neurodevelopmental impairment in children after Group B Streptococcal Disease worldwide: Systematic Review and meta-analyses. Clinical Infectious Diseases, 65, doi: 10.1093/cid/cix663

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Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on the risk of NDI after invasive GBS disease in infants 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

Publication Type: Article
Additional Information: © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords: Group B Streptococcus, impairment, infants, disability, estimate
Departments: School of Health Sciences
URI: http://openaccess.city.ac.uk/id/eprint/18762
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