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- Title
Incidence of and Neurodevelopmental Outcomes After Late-Onset Meningitis Among Children Born Extremely Preterm.
- Authors
Brumbaugh, Jane E.; Bell, Edward F.; Do, Barbara T.; Greenberg, Rachel G.; Stoll, Barbara J.; DeMauro, Sara B.; Harmon, Heidi M.; Hintz, Susan R.; Das, Abhik; Puopolo, Karen M.
- Abstract
Key Points: Question: What is the incidence of and outcomes following late-onset meningitis in children born extremely preterm? Findings: In this cohort study of 13 372 children born extremely preterm, 1% of children were diagnosed with late-onset meningitis, and 16% of these cases occurred in the absence of a concurrent positive blood culture. Those affected by late-onset meningitis had a high incidence of death or neurodevelopmental impairment. Meaning: The association of late-onset meningitis with death or neurodevelopmental impairment highlights the importance of lumbar puncture during the evaluation of late-onset infection. This cohort study reports the incidence of late-onset meningitis during birth hospitalization of neonates born extremely preterm and the neurodevelopmental outcomes at 18 to 26 months' corrected age. Importance: Late-onset meningitis (LOM) has been associated with adverse neurodevelopmental outcomes in children born extremely preterm. Objective: To report the incidence of LOM during birth hospitalization and neurodevelopmental outcomes at 18 to 26 months' corrected age. Design, Setting, and Participants: This cohort study is a secondary analysis of a multicenter prospective cohort of children born at 22 to 26 weeks' gestation between 2003 and 2017 with follow-up from 2004 to 2021. The study was conducted at 25 Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers. Exposures: Culture-confirmed LOM. Main Outcomes and Measures: Incidence and microbiology of LOM (2003-2017); lumbar puncture (LP) performance in late-onset sepsis (LOS) evaluations (2011-2017); composite outcome of death or neurodevelopmental impairment (NDI; 2004-2021). Results: Among 13 372 infants (median [IQR] gestational age, 25.4 [24.4-26.1] weeks; 6864 [51%] boys), LOM was diagnosed in 167 (1%); LOS without LOM in 4564 (34%); and neither LOS nor LOM in 8641 (65%). The observed incidence of LOM decreased from 2% (95% CI, 1%-3%) in 2003 to 0.4% (95% CI, 0.7%-1.0%) in 2017 (P <.001). LP performance in LOS evaluations decreased from 36% (95% CI, 33%-40%) in 2011 to 24% (95% CI, 21%-27%) in 2017 (P <.001). Among infants with culture-confirmed LOS, LP performance decreased from 58% (95% CI, 51%-65%) to 45% (95% CI, 38%-51%; P =.008). LP performance varied by center among all LOS evaluations (10%-59%, P <.001) and among those with culture-confirmed LOS (23%-79%, P <.001). LOM occurred in the absence of concurrent LOS in 27 of 167 cases (16%). The most common LOM isolates were coagulase-negative Staphylococcus (98 [59%]), Candida albicans (38 [23%]), and Escherichia coli (27 [16%]). Death or NDI occurred in 22 of 46 children (48%) with LOM due to coagulase-negative Staphylococcus, 43 of 67 (64%) due to all other bacterial pathogens, and 26 of 33 (79%) due to fungal pathogens. The adjusted relative risk of death or NDI was increased among children with LOM (aOR, 1.53; 95% CI, 1.04-2.25) and among those with LOS without LOM (aOR, 1.41; 95% CI, 1.29-1.54) compared with children with neither infection. Conclusions and Relevance: In this cohort study, LP was performed with decreasing frequency, and the observed incidence of LOM also decreased. Both LOM and LOS were associated with increased risk of death or NDI; risk varied by LOM pathogen. The full association of LOM with outcomes of children born extremely preterm may be underestimated by current diagnostic practices.
- Subjects
MORTALITY risk factors; RESEARCH; CULTURE; CONFIDENCE intervals; MULTIVARIATE analysis; DELAYED onset of disease; DEVELOPMENTAL disabilities; GESTATIONAL age; RISK assessment; STAPHYLOCOCCAL diseases; SEPSIS; HOSPITAL care; LUMBAR puncture; DESCRIPTIVE statistics; CHI-squared test; RESEARCH funding; MENINGITIS; LOGISTIC regression analysis; DATA analysis software; LONGITUDINAL method; SECONDARY analysis; DISEASE risk factors; DISEASE complications; CHILDREN
- Publication
JAMA Network Open, 2022, Vol 5, Issue 12, pe2245826
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.45826