Neonatal Encephalopathy With Group B Streptococcal Disease Worldwide: Systematic Review, Investigator Group Datasets, and Meta-analysis

Abstract

BackgroundNeonatal encephalopathy (NE) is a leading cause of child mortality and longer-term impairment. Infection can sensitize the newborn brain to injury; however, the role of group B streptococcal (GBS) disease has not been reviewed. This paper is the ninth in an 11-article series estimating the burden of GBS disease; here we aim to assess the proportion of GBS in NE cases.MethodsWe conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups reporting GBS-associated NE. Meta-analyses estimated the proportion of GBS disease in NE and mortality risk. UK population-level data estimated the incidence of GBS-associated NE.ResultsFour published and 25 unpublished datasets were identified from 13 countries (N = 10436). The proportion of NE associated with GBS was 0.58% (95% confidence interval [CI], 0.18%–.98%). Mortality was significantly increased in GBS-associated NE vs NE alone (risk ratio, 2.07 [95% CI, 1.47–2.91]). This equates to a UK incidence of GBS-associated NE of 0.019 per 1000 live births.ConclusionsThe consistent increased proportion of GBS disease in NE and significant increased risk of mortality provides evidence that GBS infection contributes to NE. Increased information regarding this and other organisms is important to inform interventions, especially in low- and middle-resource contexts.

Outcome of Infants with Therapeutic Hypothermia after Perinatal Asphyxia and Early-Onset Sepsis

“…Infections with GBS are still an important cause of serious morbidity in neonates [21]. In the present study, the outcome of infants with infections caused by GBS was not different from infections caused by other organisms.…”

Hospital clusters of invasive Group B Streptococcal disease: A systematic review

“…[1][2][3] Infant invasive GBS disease is classified as early-onset disease (EOD) if it occurs during the first 6 days of life or late-onset disease (LOD) if it develops 7 or more days after birth. The worldwide burden of infant and maternal GBS disease is substantial, [4][5][6][7][8][9][10][11][12][13] and efforts are under-way to develop vaccines as a preventive measure to replace or supplement antenatal screening and intrapartum antibiotics effective against early but not late-onset disease. [14][15][16][17] EOD arises from vertical transmission from a GBS colonized mother to her baby during or just before birth, with clinical signs occurring within 48 h in more than 90% of cases.…”

Neurodevelopmental Impairment in Children After Group B Streptococcal Disease Worldwide: Systematic Review and Meta-analyses

“…In addition, sepsis causes brain injury indirectly through disseminated intravascular coagulopathy and hypotension; this is important to consider in cases of neonatal sepsis without meningitis [ 15 ]. Furthermore, bloodstream infection can have a sensitizing effect in the development of hypoxic-ischemic encephalopathy, which is also associated with neurodevelopmental impairment [ 16 ].…”

“…We aimed to estimate the percentage of survivors of infant GBS disease with NDI ( Figure 1 ) as part of a supplement estimating the burden of GBS disease in pregnant women, stillbirths, and infants, which is important in terms of public health policy, particularly vaccine development, as outlined elsewhere in this supplement [ 17 ]. The supplement includes systematic reviews and meta-analyses on GBS colonization and adverse outcomes associated with GBS around birth [ 16 , 18–24 ]. These are reported individually according to international guidelines [ 25 , 26 ] and are used for estimates of the burden of GBS worldwide [ 27 ] ( Figure 1 ).…”