TY - JOUR
T1 - Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy
T2 - A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina
AU - GBS long term outcomes LMIC collaborative group
AU - Paul, Proma
AU - Chandna, Jaya
AU - Procter, Simon R.
AU - Dangor, Ziyaad
AU - Leahy, Shannon
AU - Santhanam, Sridhar
AU - John, Hima B.
AU - Bassat, Quique
AU - Bramugy, Justina
AU - Bardají, Azucena
AU - Abubakar, Amina
AU - Nasambu, Carophine
AU - Libster, Romina
AU - Yanotti, Clara Sánchez
AU - Seedat, Farah
AU - Horváth-Puhó, Erzsébet
AU - Hossain, A. K.M.Tanvir
AU - Sadeq-ur Rahman, Qazi
AU - Jit, Mark
AU - Newton, Charles R.
AU - Milner, Kate
AU - Gonçalves, Bronner P.
AU - Lawn, Joy E.
AU - Madhi, Shabir A.
AU - Harden, Lois
AU - Ghoor, Azra
AU - Mbatha, Sibongile
AU - Lowick, Sarah
AU - Laughton, Barbara
AU - Jaye, Tamara
AU - Lala, Sanjay G.
AU - Sithole, Pamela
AU - Msayi, Jacqueline
AU - Kumalo, Ntombifuthi
AU - Msibi, Tshepiso Nompumelelo
AU - Arumugam, Asha
AU - Murugesan, Nandhini
AU - Rajendraprasad, Nandhini
AU - Priya, Mohana
AU - Adan, Adam Mabrouk
AU - Katana, Patrick Vidzo
AU - Mwangome, Eva
AU - Mucasse, Humberto
AU - Aerts, Celine
AU - Massora, Sergio
AU - Medina, Valeria
AU - Rojas, Andrea
AU - Amado, Daniel
AU - Llapur, Conrado J.
N1 - Publisher Copyright:
© 2022 The Author(s)
PY - 2022/5
Y1 - 2022/5
N2 - Background: Data are limited regarding long-term consequences of invasive GBS (iGBS) disease in early infancy, especially from low- and middle-income countries (LMIC) where most cases occur. We aimed to estimate risk of neurodevelopmental impairment (NDI) in children with a history of iGBS disease. Methods: A multi-country matched cohort study was undertaken in South Africa, India, Mozambique, Kenya, and Argentina from October 2019 to April 2021. The exposure of interest was defined as a history of iGBS disease (sepsis or meningitis) before 90 days of age, amongst children now aged 1·5–18 years. Age and sex-matched, children without history of GBS were also recruited. Age-appropriate, culturally-adapted assessments were used to define NDI across multiple domains (cognitive, motor, hearing, vision, emotional-behaviour, growth). Pooled NDI risk was meta-analysed across sites. Association of iGBS exposure and NDI outcome was estimated using modified Poisson regression with robust variance estimator. Findings: Amongst 138 iGBS survivors and 390 non-iGBS children, 38·1% (95% confidence interval [CI]: 30·0% – 46·6%) of iGBS children had any NDI, compared to 21·7% (95% CI: 17·7% - 26·0%) of non- iGBS children, with notable between-site heterogeneity. Risk of moderate/severe NDI was 15·0% (95% CI: 3·4% - 30·8%) among GBS-meningitis, 5·6% (95% CI: 1·5% - 13·7%) for GBS-sepsis survivors. The adjusted risk ratio (aRR) for moderate/severe NDI among iGBS survivors was 1.27 (95% CI: 0.65, 2.45), when compared to non-GBS children. Mild impairment was more frequent in iGBS (27.6% (95% CI: 20.3 – 35.5%)) compared to non-GBS children (12.9% (95% CI: 9.7% - 16.4%)). The risk of emotional-behavioural problems was similar irrespective of iGBS exposure (aRR=0.98 (95% CI: 0.55, 1.77)). Interpretation: Our findings suggest that iGBS disease is on average associated with a higher risk of moderate/severe NDI, however substantial variation in risk was observed between sites and data are consistent with a wide range of values. Our study underlines the importance of long-term follow-up for at-risk neonates and more feasible, standardised assessments to facilitate diagnosis in research and clinical practice. Funding: This work was supported by a grant (INV-009018) from the Bill & Melinda Gates Foundation to the London School of Hygiene &Tropical Medicine.
AB - Background: Data are limited regarding long-term consequences of invasive GBS (iGBS) disease in early infancy, especially from low- and middle-income countries (LMIC) where most cases occur. We aimed to estimate risk of neurodevelopmental impairment (NDI) in children with a history of iGBS disease. Methods: A multi-country matched cohort study was undertaken in South Africa, India, Mozambique, Kenya, and Argentina from October 2019 to April 2021. The exposure of interest was defined as a history of iGBS disease (sepsis or meningitis) before 90 days of age, amongst children now aged 1·5–18 years. Age and sex-matched, children without history of GBS were also recruited. Age-appropriate, culturally-adapted assessments were used to define NDI across multiple domains (cognitive, motor, hearing, vision, emotional-behaviour, growth). Pooled NDI risk was meta-analysed across sites. Association of iGBS exposure and NDI outcome was estimated using modified Poisson regression with robust variance estimator. Findings: Amongst 138 iGBS survivors and 390 non-iGBS children, 38·1% (95% confidence interval [CI]: 30·0% – 46·6%) of iGBS children had any NDI, compared to 21·7% (95% CI: 17·7% - 26·0%) of non- iGBS children, with notable between-site heterogeneity. Risk of moderate/severe NDI was 15·0% (95% CI: 3·4% - 30·8%) among GBS-meningitis, 5·6% (95% CI: 1·5% - 13·7%) for GBS-sepsis survivors. The adjusted risk ratio (aRR) for moderate/severe NDI among iGBS survivors was 1.27 (95% CI: 0.65, 2.45), when compared to non-GBS children. Mild impairment was more frequent in iGBS (27.6% (95% CI: 20.3 – 35.5%)) compared to non-GBS children (12.9% (95% CI: 9.7% - 16.4%)). The risk of emotional-behavioural problems was similar irrespective of iGBS exposure (aRR=0.98 (95% CI: 0.55, 1.77)). Interpretation: Our findings suggest that iGBS disease is on average associated with a higher risk of moderate/severe NDI, however substantial variation in risk was observed between sites and data are consistent with a wide range of values. Our study underlines the importance of long-term follow-up for at-risk neonates and more feasible, standardised assessments to facilitate diagnosis in research and clinical practice. Funding: This work was supported by a grant (INV-009018) from the Bill & Melinda Gates Foundation to the London School of Hygiene &Tropical Medicine.
KW - Disability
KW - Group B streptococcus
KW - Impairment
KW - Infants
KW - Meningitis
KW - Neurodevelopment
KW - Sepsis
KW - children
UR - http://www.scopus.com/inward/record.url?scp=85129986643&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2022.101358
DO - 10.1016/j.eclinm.2022.101358
M3 - Article
AN - SCOPUS:85129986643
SN - 2589-5370
VL - 47
JO - eClinicalMedicine
JF - eClinicalMedicine
M1 - 101358
ER -