Incidence of and Neurodevelopmental Outcomes After Late-Onset Meningitis Among Children Born Extremely Preterm
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Published:2022-12-08
Issue:12
Volume:5
Page:e2245826
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Brumbaugh Jane E.1, Bell Edward F.2, Do Barbara T.3, Greenberg Rachel G.4, Stoll Barbara J.56, DeMauro Sara B.7, Harmon Heidi M.2, Hintz Susan R.8, Das Abhik9, Puopolo Karen M.7, Ambalavanan Namasivayam10, Bailey Kirstin J.10, Biasini Fred J.10, Carlo Waldemar A.10, Chopko Stephanie A.10, Collins Monica V.10, Cosby Shirley S.10, Johnston Kristen C.10, Moses Mary Beth10, Nelson Kathleen G.10, Patterson Cryshelle S.10, Peralta-Carcelen Myriam10, Phillips Vivien A.10, Preskitt Julie10, Rector Richard V.10, Whitley Sally10, Alksninis Barbara10, Bishop Carmena10, Burke Robert T.10, Caskey Melinda10, Hensman Angelita M.10, Hoffman Laurie10, Johnson Katharine10, Keszler Martin10, Keszler Mary Lenore10, Knoll Andrea M.10, Lamberson Vita10, Laptook Abbot R.10, Leach Theresa M.10, Little Emilee10, McGowan Elizabeth C.10, Oh William10, St. Pierre Lucille10, Stephens Bonnie E.10, Ventura Suzy10, Vieira Elisa10, Vohr Betty R.10, Watson Victoria E.10, Coleman Kelly R.10, Guilford Stephanie10, Hartley-McAndrew Michelle E.10, Lakshminrusimha Satyan10, Li Emily10, Reynolds Anne Marie10, Sacilowski Michael G.10, Williams Ashley10, Zorn William A.10, Bhola Monika10, Fanaroff Avroy A.10, Friedman Harriet G.10, Hibbs Anna Maria10, Newman Nancy S.10, Payne Allison H.10, Siner Bonnie S.10, Walsh Michele C.10, Wilson-Costello Deanne E.10, Yalcinkaya Gulgun10, Caplan Michael S.10, Alexander Barbara10, Beiersdorfer Traci10, Bridges Kate10, Cahill Tanya E.10, Donovan Edward F.10, Dudley Juanita10, Fischer Estelle E.10, Gratton Teresa L.10, Grisby Cathy10, Hayes Devan10, Hessling Jody10, Jackson Lenora Denise10, Jobe Alan H.10, Kallapur Suhas G.10, Kirker Kristin10, Merhar Stephanie L.10, Mincey Holly L.10, Muthig Greg10, Poindexter Brenda B.10, Schibler Kurt10, Stacey Sara10, Steichen Jean J.10, Tepe Stacey10, Thompson Julia10, Worley Mersmann Marcia10, Wuertz Sandra10, Yolton Kimberly10, Polin Richard A.10, Adams Sally S.10, Brion Luc P.10, Chen Lijun10, De Leon Maria M.10, Eubanks Frances10, Guzman Alicia10, Hensley Gaynelle10, Heyne Elizabeth T.10, Heyne Roy J.10, Hickman Jackie F.10, Lee Lizette E.10, Leps Melissa H.10, Madden Linda A.10, McDougald E. Rebecca10, Miller Nancy A.10, Morgan Janet S.10, Pavageau Lara10, Rosenfeld Charles R.10, Salhab Walid A.10, Sánchez Pablo J.10, Sepulveda Pollieanna10, Twell Boatman Catherine10, Vasil Diana M.10, Waterbury Jillian10, Wyckoff Myra H.10, Ashley Patricia L.10, Auten Kathy J.10, Cotten C. Michael10, Finkle Joanne10, Fisher Kimberley A.10, Goldberg Ronald N.10, Goldstein Ricki F.10, Grimes Sandra10, Gustafson Kathryn E.10, Lohmeyer Melody B.10, Malcolm William F.10, Adams-Chapman Ira10, Blackwelder Ann10, Bottcher Diane I.10, Carlton David P.10, Carter Sheena L.10, Hale Ellen C.10, Kendrick-Allwood Salathiel10, Laursen Judith10, Loggins Yvonne C.10, Mackie Colleen10, Mulligan LaRossa Maureen10, Patel Ravi M.10, Sanders Amy10, Seabrook Irma10, Smikle Gloria V.10, Wineski Lynn10, Akpa Esther G.10, Alaniz Nora I.10, Allain Elizabeth10, Arldt-McAlister Julie10, Bradt Pamela J.10, Burson Katrina10, Dempsey Allison G.10, Dieterich Susan E.10, Duncan Andrea F.10, Eason Elizabeth10, Evans Patricia W.10, Foley Harris Beverly10, Franco Claudia I.10, Garcia Carmen10, Green Charles E.10, Hall Donna J.10, Jimenez Margarita10, John Janice10, Jones Patrick M.10, Kennedy Kathleen A.10, Khan Amir M.10, Khan Siddiki Saba10, Lillie Layne10, Lis Anna E.10, Major-Kincade Terri L.10, Martin Karen10, Martin Sara C.10, McDavid Georgia Elaine10, McKee Shannon L.10, Morris Brenda H.10, Orekoya Patricia Ann10, Pedrozza Claudia10, Perez Carrie M.10, Pierce Tate Patti L.10, Reddoch Stacey10, Rodgers Shawna10, Simmons Maegan C.10, Sperry Daniel K.10, Stephens Emily K.10, Tyson Jon E.10, Whitely Laura L.10, Wright Sharon L.10, Dusick Anna M.10, Gunn Susan10, Hamer Faithe10, Herron Dianne E.10, Hines Abbey C.10, Joyce Jeffery10, Lemons James A.10, Lytle Carolyn10, Miller Lucy C.10, Minnich Heike M.10, Papile Lu-Ann10, Richard Leslie10, Smiley Lucy C.10, Sokol Gregory M.10, Wilson Leslie Dawn10, Acarregui Michael J.10, Colaizy Tarah T.10, Dagle John M.10, Eastman Diane L.10, Goeke Claire A.10, Johnson Karen J.10, Klein Jonathan M.10, Krutzfield Nancy J.10, Schmelzel Mendi L.10, Walker Jacky R.10, Widness John A.10, Bass Donia B.10, Ellsbury Dan L.10, Tud Tracy L.10, Bauer Charles R.10, Calejo Maria10, Duara Shahnaz10, Everett-Thomas Ruth10, Fajardo-Hiriart Sylvia10, Frade Eguaras Silvia M.10, Garcia Andrea10, Harwood Berkovits Michelle10, Pierre Helina10, Riguard Arielle10, Stoerger Alexandra10, Gaetano Lisa10, Gauldin Cheri10, Holmes Anne M.10, Johnson Kathy10, Kilbride Howard W.10, Pallotto Eugenia K.10, Parimi Prabhu S.10, Scott Allison10, Truog William E.10, Besner Gail E.10, Clark Erna10, Fortney Christine A.10, Gutentag Julie10, Jadcherla Sudarshan R.10, Luzader Patricia10, Maitre Nathalie L.10, Nelin Leif D.10, Parikh Nehal A.10, Park Courtney10, Shadd Julie C.10, Stein Melanie10, Sullivan Margaret10, Bremer Andrew A.10, Higgins Rosemary D.10, Wilson Archer Stephanie10, Abbasi Soraya10, Bernbaum Judy C.10, Catts Christine10, Chaudhary Aasma S.10, Cook Noah10, Cucinotta Dara M.10, Eichenwald Eric C.10, Gerdes Marsha10, Ghavam Sarvin10, Hurt Hallam10, Kirpalani Haresh10, Mancini Toni10, Schmidt Barbara10, Snyder Jonathan M.10, Vangala Sarith10, Ziolkowski Kristina10, Babish Johnson Julie10, Binion Kyle10, Bowman Melissa10, Burnell Erica10, D'Angio Carl T.10, Fallone Caitlin10, Farooq Osman10, Guillet Ronnie10, Horihan Cassandra A.10, Hunn Julianne10, Hust Diane10, Jensen Rosemary L.10, Jones Rachel10, Kachelmeyer Jennifer10, Kent Alison10, Kushner Emily10, Maffett Deanna10, McKee Kimberly G.10, Merzbach Joan10, Myers Gary J.10, Orme Constance10, Phelps Dale L.10, Prinzing Diane M.10, Reubens Linda J.10, Rochez Daisy10, Rowan Mary10, Sabaratnam Premini10, Scorsone Ann Marie10, Wadkins Holly I.M.10, Yost Kelley10, Zwetsch Lauren10, Bann Carla M.10, Crawford Margaret M.10, Gabrio Jenna10, Gantz Marie G.10, Hastings Betty K.10, Leblond David10, Newman Jamie E.10, O’Donnell Auman Jeanette10, Petrie Huitema Carolyn M.10, Poole W. Kenneth10, Wallace Dennis10, Zaterka-Baxter Kristin M.10, Baack Michelle L.10, Broadbent Megan10, Elenkiwich Chelsey10, Henning Megan M.10, Hogden Laurie A.10, Adams Marian M.10, Bahmani Dona10, Ball M. Bethany10, Bentley Barbara10, Bruno Elizabeth F.10, Chock Valerie Y.10, Davis Alexis S.10, DeAnda Maria Elena10, DeBattista Anne M.10, Earhart Beth A.10, Huffman Lynne C.10, Ismael Magdy10, Kohn Jean G.10, Krueger Casey E.10, Lee-Ancajas Julie C.10, Lowe Janice10, Lucash Ryan E.10, Palmquist Andrew W.10, Patel Jessica10, Proud Melinda S.10, Reichert Elizabeth N.10, Sivakumar Dharshi10, St. John Nicholas H.10, Stevenson David K.10, Taylor Heather L.10, Van Meurs Krisa P.10, Wager Natalie10, Williams R. Jordan10, Weiss Hali10, Brussa Ana K.10, Church Paige T.10, Fiascone John M.10, Frantz Ivan D.10, Furey Anne10, Kurfiss Anne10, MacKinnon Brenda L.10, McGowan Elisabeth C.10, Nylen Ellen10, Sibley Cecelia E.10, Chanlaw Teresa10, Devaskar Uday10, Garg Meena10, Geller Rachel10, Purdy Isabell B.10, Arnell Kathy10, Demetrio Clarence10, Finer Neil N.10, Fuller Martha G.10, Henderson Christopher10, Kaegi David10, Rasmussen Maynard R.10, Rich Wade10, Vaucher Yvonne E.10, Wozniak Paul R.10, Bernhardt Janice10, Bose Carl L.10, Bose Gennie10, Clark Cynthia L.10, Laughon Matthew Maxwell10, Warner Diane D.10, Wereszczak Janice Kay10, Backstrom Lacy Conra10, Dupont Tara10, Fuller Janell10, Hanson Mary10, Hartenberger Carol H.10, Kuan Elizabeth10, Lowe Jean R.10, Ohls Robin K.10, Sundquist Beauman Sandra10, Thomson Rebecca A.10, Watterberg Kristi L.10, Barks John10, Carlson Martha D.10, Christensen Mary K.10, Wiggins Stephanie A.10, Sarkar Subrata10, Baker Shawna10, Baserga Mariana10, Bird Karie10, Burnett Jill10, Christensen Susan10, Cole Bledsoe Laura10, Cunningham Sean D.10, Davis Brandy10, Elmont Jennifer O.10, Faix Roger G.10, Hall Becky10, Jensen Erika R.10, Jensen Jennifer J.10, Jordan Jamie10, Loertscher Manndi C.10, Marchant Trisha10, Maxson Earl10, McGrath Kandace M.10, Minton Stephen D.10, Morshedzadeh Galina10, Osborne Karen A.10, Parry D. Melody10, Rau Carrie A.10, Reich Brixen A.10, Schaefer Susan T.10, Sheffield Mark J.10, Spencer Cynthia10, Steffen Michael10, Stout Kelly10, Stuart Ashley L.10, Tice Katherine10, Weaver-Lewis Kimberlee10, Winter Sarah10, Woodbury Kathryn D.10, Yoder Bradley A.10, Zanetti Karen10, Chiu Korinne10, Dillard Robert G.10, Evans Allred Deborah10, Goldstein Donald J.10, Halfond Raquel10, Jackson Barbara G.10, O’Shea T. Michael10, Peters Nancy J.10, Peterson Carroll10, Waldrep Ellen L.10, Washburn Lisa K.10, Welch Cherrie D.10, Whalen Morris Melissa10, Wiley Hounshell Gail10, Kicklighter Stephen D.10, Rhodes-Ryan Ginger10, White Donna10, Abramczyk Katherine10, Agarwal Prashant10, Bajaj Monika10, Bara Rebecca10, Billian Elizabeth10, Chawla Sanjay10, Childs Kirsten10, De Jesus Lilia C.10, Driscoll Debra10, February Melissa10, Goldston Laura A.10, Johnson Mary E.10, Muran Geraldine10, Natarajan Girija10, Panaitescu Bogdan10, Pappas Athina10, Prentice Jeannette E.10, Shankaran Seetha10, Sood Beena G.10, White Diane F.10, Woldt Eunice10, Butler Christine G.10, Cervone Patricia10, Ehrenkranz Richard A.10, Gettner Patricia10, Greisman Sheila10, Jacobs Harris C.10, Konstantino Monica10, Poulsen JoAnn10, Romano Elaine10, Taft Janet10, Williams Joanne10,
Affiliation:
1. Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 2. Department of Pediatrics, University of Iowa, Iowa City 3. Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina 4. Department of Pediatrics, Duke University, Durham, North Carolina 5. Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, Georgia 6. McGovern Medical School of UTHealth, Houston, Texas 7. Department of Pediatrics, University of Pennsylvania, Philadelphia 8. Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California 9. Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland 10. for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Abstract
ImportanceLate-onset meningitis (LOM) has been associated with adverse neurodevelopmental outcomes in children born extremely preterm.ObjectiveTo report the incidence of LOM during birth hospitalization and neurodevelopmental outcomes at 18 to 26 months’ corrected age.Design, Setting, and ParticipantsThis 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.ExposuresCulture-confirmed LOM.Main Outcomes and MeasuresIncidence 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).ResultsAmong 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 RelevanceIn 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.
Publisher
American Medical Association (AMA)
Cited by
8 articles.
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