Intrapartum GBS prophylaxis does not prevent long-term morbidity of GBS meningitis

IDSA 49th Annual Meeting

Issue: November 2011

BOSTON — Mortality rates from group B streptococcal meningitis have declined, but morbidity among survivors remains high, despite intrapartum prophylaxis, according to Romina Libster, MD.

The aim of the trial was to assess the outcomes of group B streptococcal meningitis in infants at and near term and examine the factors associated with the outcomes. Libster, of Vanderbilt University in Nashville, and colleagues analyzed follow-up data for 42 children diagnosed with GBS meningitis at term and near-term from 1998 to 2006 at the Texas Children’s Hospital and Monroe Carell Jr. Children’s Hospital.

Physical and neurological examinations, hearing and visual screenings and psychological tests were performed on those children who returned for examination; data were compared with those for children who did not return for evaluation.

WIAT II and Mullen Scales of Early Learning were used. To define neurological sequelae severity, Libster and colleagues used the following criteria:

Normal: WIAT II standard scores, Mullen T scores, or cognitive standard scores +/- 1 standard deviation (SD) from the mean and no neurological or functional impairment.
Mild to moderate impairment: WIAT II scores 1-2 SD below the mean, or >15 point split between subtest categories; Mullen T scores 1-2 SD below the mean in one or more domains or cognitive T scores between 1-2 standard deviations below the mean, or evidence of mild or moderate neurological or functional impairment.
Severe impairment: WIAT II and Mullen T scores >2 SD below the mean in 1 or more areas of achievement or domains, or evidence of severe neurological or functional impairment.

Approximately one-half of patients had some impairment: 30% had mild to moderate sequelae and about 20% of patients had severe sequelae or late death, she told Infectious Diseases in Children. Factors associated with death or severe impairment upon admission included: lethargy, respiratory distress, coma or semicoma, seizures, bulging fontanel, leukopenia, acidosis, CFS proteins >300 mg/dL, CSF glucose <20 mg/dL, need for ventilatory support or need for pressor support.

Additionally, children who failed the hearing screening, had an abnormal neurological exam or had abnormal brain imaging were also at increased risk for death or abnormal developmental examinations at discharge.

“The important thing here is that we already know these patients are going to have impairment at discharge, but what happened with those children that are in the mild to moderate group? Why do they have some impairments that are not evident when they go to follow-up? In these children, when they come to follow-up, we should ask for the psychological and developmental evaluation to try to optimize their skills; this is the most important thing.” — by Stacey L. Fisher

Disclosure: Dr. Libster reports no relevant financial disclosures.

For more information:

Libster R. #946. Presented at: IDSA 49th Annual Meeting; Oct. 20-23, 2011; Boston.

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