South Indian Children’s Neurodevelopmental Outcomes After Group B Streptococcus Invasive Disease: A Matched-Cohort Study

Abstract

Introduction This study is part of a multi- country matched cohort study designed to estimate the risk of long term neurodevelopmental of children exposed to iGBS. The specific objective of this paper is to compare NDI across domains of iGBS survivors with a matched non-GBS group in our population. Methods Survivors of iGBS in a south Indian hospital were identified and recruited between January 2020 and April 2021. Cases were compared with age and gender matched non-GBS children. Participants were assessed using Bayley Scales of infant and toddler development (BSID-III), Wechsler Preschool and Primary Scale of Intelligence (WPPSI- IV), Wechsler Intelligence Scale for Children (WISC- V), Child behaviour checklist (CBCL) and Bruininks- Oseretsky Test of Motor Proficiency (BOT-2) depending on age. Results Our cohort comprised 35 GBS exposed and 65 matched non-GBS children, aged 1- 14 years. iGBS exposed group had 17 (48.6%) children with impairment in at least one domain compared to 25 (38%) in the non-GBS group [Unadjusted OR- 1.51, 95%CI 0.65- 3.46], 9 (26%) children with ‘multi domain impairment’ compared to 10 (15.4%) in the non-GBS group [Unadjusted OR- 1.90, 95% CI 0.69- 5.24] and 1 (2.9%) child with moderate to severe impairment compared to 3 (4.6%) in the non-GBS group [Unadjusted OR- 0.60, 95%CI 0.06- 6.07]. In the iGBS group, more children had motor impairments compared to the non-GBS group [Unadjusted OR- 10.7, 95%CI 1.19- 95.69, p= 0.034] Conclusion Children with iGBS seem at higher risk of developing motor impairments compared to a non-GBS group.

20 million pregnant women with group B streptococcus carriage: consequences, challenges, and opportunities for prevention

“…However, this pathogen is also associated with other health outcomes [2] (Fig. 1), including as a causative factor for stillbirths [3], and a risk factor for preterm births [4] and for long-term sequelae in survivors of acute disease [5,6 ▪▪ ,7,8,9 ▪ ,10 ▪▪ ]. It was estimated that 46,200 (95% posterior interval 20,300–111,300) stillbirths resulted from in utero GBS infection in 2020, and up to 518,100 (36,900–1142,300) preterm births might have been associated with GBS colonisation [1 ▪▪ ].…”

Mortality and neurodevelopmental outcome after invasive group B streptococcal infection in infants

“…However, the Danish cohort comprised fewer infants born preterm (21% vs 31% in our study) and included cases not confirmed by culture 9 . Four studies from low‐income countries reported that 27.9% to 50.0% of infants surviving GBS infection had any neurodevelopmental impairment 28–31 . In total, 273 children with invasive GBS infection during infancy were included in these studies, and the follow‐up ranged from 1 to 18 years.…”

“…9 Four studies from low-income countries reported that 27.9% to 50.0% of infants surviving GBS infection had any neurodevelopmental impairment. [28][29][30][31] In total, 273 children with invasive GBS infection during infancy were included in these studies, and the follow-up ranged from 1 to 18 years. Despite different estimates, the main results of these studies as well as those reported by Kadambari et al and Horváth-Puhó et al agree with our findings, indicating a substantial burden of NDDs following invasive GBS infection.…”

Bacterial and Host Determinants of Group B Streptococcal Infection of the Neonate and Infant

“…A cohort study of GBS meningitis survivors in the United States assessed children younger than 6 years using the Mullen Scales of Early Learning to assess language, motor and cognitive ability. A similar study in children from South India showed that survivors of invasive GBS infection had greater motor impairment compared to age-matched children who were not exposed to GBS ( John et al, 2022 ). Impaired neurologic functioning was observed in 50% (9/18) of patients and 28% (5/18) experiencing severe impairment ( Libster et al, 2012 ).…”