Acute-Phase Neurologic Complications of Haemophilus Influenzae Type b Meningitis: Association With Developmental Problems at School Age

Abstract

The purposes of this study were to describe the incidence of acute-phase neurologic complications in a sample of 126 children with Haemophilus influenzae type b meningitis, and to determine if these complications were associated with higher rates of learning and behavior problems at school age. Risks were assessed by comparing rates of adverse psychoeducational outcomes in the 53 children in the sample with complications to corresponding outcome rates in the 67 children who were free of neurologic complications and who did not have abnormal electroencephalograms (EEGs) or computed tomographic (CT) scans. Comparisons were made by means of logistic regression analysis. Twenty-nine children (23% of the sample) had seizures, 16 (13%) were comatose or obtunded, 15 (12%) had sensorineural hearing loss, 8 (6%) had hemiparesis, and 7 (6%) had cranial nerve deficits other than hearing loss. Relative to children without complications, those with complications had higher rates of grade repetition and substandard performance on neuropsychological and achievement testing. Adverse outcomes, however, consisted primarily of more subtle cognitive and learning problems; only two of the children in the sample obtained prorated IQ scores below 70. Sequelae were associated with persistent neurologic deficits and bilateral hearing loss, as well as with transient symptoms including seizures, coma, and hemiparesis. While study findings argue against adverse consequences for the vast majority of children treated for this disease, the results clarify learning and behavior outcomes and indicate which children are at greatest risk.

Prediction of academic and behavioural limitations in school-age survivors of bacterial meningitis

“…Most of the risk factors found in our study have been reported previously (2,6,7,9,11,(13)(14)(15). However, these authors all studied death or severe sequelae simultaneously with academic and/or behavioural limitations as outcome, and none of these studies provided a prediction rule to detect children at high risk for these limitations (2,6,7,9,11,(13)(14)(15).…”

“…However, these authors all studied death or severe sequelae simultaneously with academic and/or behavioural limitations as outcome, and none of these studies provided a prediction rule to detect children at high risk for these limitations (2,6,7,9,11,(13)(14)(15). Furthermore, most studies included children with Hib meningitis (2,6,9,11,13,15).…”

“…More subtle adverse outcomes such as cognitive, academic and behavioural problems are present in over 20% (4)(5)(6)(7)(9)(10)(11)(12)(13). These problems often remain undetected until the children start school, several years after they have been cured of their meningitis.…”

“…These problems often remain undetected until the children start school, several years after they have been cured of their meningitis. As a result, more of these children require special education and end up repeating the year (5,11). Early detection of academic and behavioural problems may enable prompt and adequate treatment and thus prevent worsening.…”

“…Several risk factors for severe and more subtle sequelae after bacterial meningitis have been proposed, including male gender, young age at illness, acute-phase neurological complications and S. pneumoniae as the infective pathogen (2,6,7,9,11,(13)(14)(15). However, academic and/or behavioural problems were not specifically addressed and none of the reports provided comprehensive prediction rules, which could be used in practice to detect children at high risk.…”