Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina
<strong>Background</strong> 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...
| Автори: | , , , , , , , , , , , , , , , , , , , , , , |
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| Інші автори: | |
| Формат: | Journal article |
| Мова: | English |
| Опубліковано: |
Elsevier
2022
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| _version_ | 1826308197538856960 |
|---|---|
| author | Paul, P Chandna, J Procter, SR Dangor, Z Leahy, S Santhanam, S John, HB Bassat, Q Bramugy, J Bardají, A Abubakar, A Nasambu, C Libster, R Yanotti, CS Seedat, F Horváth-Puhó, E Hossain, AKMT Sadeq-Ur Rahman, Q Jit, M Newton, CR Milner, K Gonçalves, BP Lawn, JE |
| author2 | GBS long term outcomes LMIC collaborative group |
| author_facet | GBS long term outcomes LMIC collaborative group Paul, P Chandna, J Procter, SR Dangor, Z Leahy, S Santhanam, S John, HB Bassat, Q Bramugy, J Bardají, A Abubakar, A Nasambu, C Libster, R Yanotti, CS Seedat, F Horváth-Puhó, E Hossain, AKMT Sadeq-Ur Rahman, Q Jit, M Newton, CR Milner, K Gonçalves, BP Lawn, JE |
| author_sort | Paul, P |
| collection | OXFORD |
| description | <strong>Background</strong>
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.
<br>
<strong>Methods</strong>
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.
<br>
<strong>Findings</strong>
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)).
<br>
<strong>Interpretation</strong>
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.
<br>
<strong>Funding</strong>
This work was supported by a grant (INV-009018) from the Bill & Melinda Gates Foundation to the London School of Hygiene & Tropical Medicine. |
| first_indexed | 2024-03-07T07:14:25Z |
| format | Journal article |
| id | oxford-uuid:d27861e5-5ebc-4cef-a12a-d2df353b4133 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:14:25Z |
| publishDate | 2022 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:d27861e5-5ebc-4cef-a12a-d2df353b41332022-07-21T11:00:15ZNeurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and ArgentinaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:d27861e5-5ebc-4cef-a12a-d2df353b4133EnglishSymplectic ElementsElsevier2022Paul, PChandna, JProcter, SRDangor, ZLeahy, SSanthanam, SJohn, HBBassat, QBramugy, JBardají, AAbubakar, ANasambu, CLibster, RYanotti, CSSeedat, FHorváth-Puhó, EHossain, AKMTSadeq-Ur Rahman, QJit, MNewton, CRMilner, KGonçalves, BPLawn, JEGBS long term outcomes LMIC collaborative group<strong>Background</strong> 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. <br> <strong>Methods</strong> 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. <br> <strong>Findings</strong> 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)). <br> <strong>Interpretation</strong> 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. <br> <strong>Funding</strong> This work was supported by a grant (INV-009018) from the Bill & Melinda Gates Foundation to the London School of Hygiene & Tropical Medicine. |
| spellingShingle | Paul, P Chandna, J Procter, SR Dangor, Z Leahy, S Santhanam, S John, HB Bassat, Q Bramugy, J Bardají, A Abubakar, A Nasambu, C Libster, R Yanotti, CS Seedat, F Horváth-Puhó, E Hossain, AKMT Sadeq-Ur Rahman, Q Jit, M Newton, CR Milner, K Gonçalves, BP Lawn, JE Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina |
| title | Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina |
| title_full | Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina |
| title_fullStr | Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina |
| title_full_unstemmed | Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina |
| title_short | Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina |
| title_sort | neurodevelopmental and growth outcomes after invasive group b streptococcus in early infancy a multi country matched cohort study in south africa mozambique india kenya and argentina |
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