Group B Streptococcal Meningitis in Neonate: 2001-2011

Jiin Cheong; Shin-yun Byun; Myo-Jing Kim

doi:10.14734/kjp.2013.42.2.142

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Cheong, Byun, and Kim: Group B Streptococcal Meningitis in Neonate: 2001-2011

Original Article

Korean J Perinatol 2013;24(3):142-147.

Published online: 19 June 2013

DOI: https://doi.org/10.14734/kjp.2013.42.2.142

Group B Streptococcal Meningitis in Neonate: 2001-2011

Jiin Cheong, M.D.¹, Shin-yun Byun, M.D.², Myo-Jing Kim, M.D.^1,

¹Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea

²Department of Pediatrics∗, Busan National University College of Medicine, Busan, Korea

주관책임자 : 김묘징, 602-714 부산시 서구 동대신동 3가 1번지동아대학교 의과대학 소아과학교실 전화 : 051)240-5124, 전송 : 051)242-2765 E-mail : neonate.kr@gmail.com 본 논문은 동아대학교 연구 기금에 의해 지원되었음

Received 9 October 2013 Revised 2 January 2013 Accepted 16 January 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose :

Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and meningitis. Little is known about neonatal GBS infection in Korea. We investigated the clinical characteristics of GBS meningitis in neonate.

Methods :

We retrospectively analyzed 15 medical records of patients who diagnosed neonatal GBS meningitis admitted to two tertiary centers from January 2001 to December 2011. We analyzed the patient's characteristics, clinical symptoms and signs at admission, laboratory findings, and short-term outcomes at discharge.

Results :

Among a total of 15 patients, five patients had early GBS meningitis and ten patients had late GBS meningitis. The most frequent clinical onset time was after three weeks of age. The major clinical symptom was respiratory difficulty in early GBS meningitis and fever in late GBS meningitis. The mortality rate was 6.7%. Among 15 patients, eight patients (53.3%) had abnormalities on neuroimaging studies at discharge and most of these patients were late GBS meningitis.

Conclusion :

Late GBS meningitis was the majority of neonatal GBS meningitis and had poor short-term neurological outcomes. To prevent the late GBS meningitis, we need to nation-wide preventive study including the incidence, mortality, and long-term outcomes of neonatal GBS meningitis.

Keywords: Neonatal meningitis, Group B streptococcus

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Table 1.

Clinical Characteristics of the Study Patients

Variables	EOD, N=5 (%)	LOD, N=10 (%)	Total, N=15 (%)
Gestational age, weeks	34.4±6.2	38.0±6.7	37.3±1.9
Birth weight, g	2,568.0±1,238.4	2,958.0±397.2	2,828.0±758.9
Male	3 (60.0)	6 (60.0)	9 (60.0)
NSVD	4 (80.0)	5 (50.0)	9 (60.0)
AS1	7.0±1.9	8.9±0.3	8.3±1.4
AS5	8.2±1.8	9.8±0.4	9.3±1.3
Age at onset, days	1±0.5	31.9±14.4	21.5±19.2
≤7 days	5 (100.0)	0	5 (33.3)
1-2 weeks	0	0	0
2-3 weeks	0	1 (10.0)	1 (6.7)
3-4 weeks	0	5 (50.0)	5 (33.3)
>4 weeks	0	4 (40.0)	4 (26.7)
Admission weight, g	2,556.0±1228.9	4,426.0±846.7	3,802.7±1,313.4
Hospital duration, days	39.8±37.9	21.1±9.7	27.3±23.5
Death	0	1 (10.0)	1 (6.7)

Abbreviations : EOD, early-onset disease; LOD, late-onset disease; NSVD, normal spontaneous vaginal delivery; AS1, apgar score at one minute; AS5, apgar score at five minutes.

Table 2.

Clinical Manifestations of Group B Streptococcus Meningitis

Variables	EOD, N=5 (%)	LOD, N=10 (%)	Total, N=15 (%)
Poor feeding	3 (60.0)	9 (90.0)	12 (80.0)
Fever	0	10 (100.0)	10 (66.7)
Respiratory difficult	ty 5 (100.0)	4 (40.0)	9 (60.0)
Ventilator care	3 (60.0)	4 (40.0)	7 (46.7)
Lethargy	1 (20.0)	8 (80.0)	9 (60.0)
Pallor	3 (60.0)	3 (30.0)	6 (40.0)
Irritability	2 (40.0)	3 (30.0)	5 (33.3)
Hypotonia	1 (20.0)	3 (30.0)	4 (26.7)
Hypotension	1 (20.0)	3 (30.0)	4 (26.7)
Seizure	0	2 (20.0)	2 (13.3)

Abbreviations : EOD, early-onset disease; LOD, late-onset disease.

Table 3.

Laboratory Findings of the Study Patients

Variables	EOD, N=5	LOD, N=10	Total, N=15
CSF analysis
WBC, /mm³	19.6±34.4	1151.1±1239.9	893.0±1,180.6
PMN, %	10.6±18.6	60.3±35.1	65.6±26.6
RBC, /mm³	13,200.0±29,516.1	239.7±724.5	4,559.8±17,007.2
Protein, mg/dL	122.8±137.1	448.7±451.8	392.4±408.2
Glucose, mg/dL	40.8±38.9	27.5±20.0	36.8±25.6
Blood analysis
WBC, /mm³	12,980.0±10,075.4	7,461.1±6,840.4	9,300.7±8,144.7
PMN, %	71.4±13.0	39.9±17.9	50.4±22.2
PLT, ×10³	235.6±82.1	356.8±168.8	316.4±154.1
Hb, mg/dL	15.0±2.9	10.9±1.7	12.2±2.9
CRP, mg/dL	2.4±4.5	7.1±7.4	5.5±6.8

Abbreviations: EOD, early-onset disease; LOD, late-onset disease; PMN, polymorphoneuclear leukocyte; RBC, red blood cell; PLT, platelet; CRP, C-reactive protein.

Table 4.

Neuroimaging Abnormalities of Group B Strep tococcus Meningitis

	EOD, N=5 (%)	LOD, N=10 (%)	Total, N=15 (%)
Normal	4 (80.0)	3 (30.0)	7 (46.7)
Abnormal	1 (20.0)	7 (70.0)	8 (53.3)
Cerebromalacia	a 1	2	3 (20.0)
Cerebral infarcti	ion 0	2	2 (13.3)
Subdural effusio	n 0	2	2 (13.3)
Brain abscess	0	1	1 (6.7)
Hydrocephalus	1	0	1 (6.7)

Abbreviations: GBS, Group B Streptococcus; EOD, early onset disease; LOD, late-onset disease.

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