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

Abstract

Aim: To develop a prediction rule to identify postmeningitic children at high risk of academic and behavioural limitations. Methods: 182 children (mean age 10 y; range 5-14) were selected from a cohort of 674 school-age survivors of bacterial meningitis. These children had neither meningitis with "complex onset", nor prior cognitive or behavioural problems, nor severe disease sequelae. On average, 7 y after the meningitis, they were evaluated using an "Academic Achievement Test", and their parents filled in the "Child Behaviour Checklist". By reviewing the medical records, potential risk factors for academic and/or behavioural limitations were collected. Independent predictors were identified using multivariate logistic regression analysis, leading to the formulation of a prediction rule. Results: The cumulative incidence of academic and/or behavioural limitations among children who survived bacterial meningitis without severe disease sequelae was 32%. The prediction rule was based on nine independent risk factors: gender, birthweight, educational level of the father, S. pneumoniae, cerebrospinal fluid leukocyte count, delay between admission and start of antibiotics, dexamethasone use, seizures treated with anticonvulsive therapy, and prolonged fever. When 10 was taken as a cut-off point for the risk score computed using this rule, 76% of the children with limitations could be identified, while 38% of the children in the cohort were selected as at risk for these limitations. Conclusion:With a prediction rule based on nine risk factors, postmeningitic children at high risk of developing academic and/or behavioural limitations could be identified. Additional research is required to further validate this prediction rule. In the future, a careful follow-up of high risk children may enhance early detection and treatment of these limitations.

Polymorphisms in Toll-Like Receptors 2, 4, and 9 Are Highly Associated with Hearing Loss in Survivors of Bacterial Meningitis

“…The cohort of school age children in part with post-meningitis hearing loss is composed of two independent cohorts. Both cohorts were described in detail in other studies [44], [45]. Both cohorts appeared to be rather similar [46] and no significant differences in genotype distributions were observed between both cohorts.…”

“…Determination of SNPs in an early stage of BM may be useful to identify children at risk to develop sequelae and to add host genetic markers to current clinical prediction rules on complications after BM such as hearing loss and academic and behavioral limitations [44], [45].…”

“…Outliers were excluded (<4%) by the Grubbs’ test ( p <0.01) before continuous testing. Next, continuous variables were dichotomized based on clinical relevant cut-off points as described in literature [44], [45] or as used in clinical practice. After Holm-Bonferroni correction for multiple testing, p-values <0.003 were considered to be statistically significant.…”

Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies

“…Sensorineural hearing loss, seizures, motor problems, hydrocephalus and mental retardation [4,7-10], as well as more subtle outcomes like cognitive, academic and behavioral problems are observed in post-meningitis children [5,11]. …”

“…Therefore, early recognition of children with BM with high risk for the development of sequelae is mandatory [5,12-15]. For this reason, several studies have developed prediction models or have proposed prognostic factors for mortality or morbidity in children after BM [5-9,12-37]. The aim of the present study was to systematically review the available evidence regarding prognostic factors predicting death or sequelae due to BM in children aged 0-18 years in both developing and developed countries.…”