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Long-term outcomes after group B streptococcus infection: a cohort study
  1. Kee Thai Yeo1,2,
  2. Monica Lahra3,
  3. Barbara Bajuk4,
  4. Lisa Hilder5,
  5. Mohamed E Abdel-Latif6,7,
  6. Ian M Wright8,9,10,
  7. Ju-Lee Oei2,11
  1. 1Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
  2. 2Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
  3. 3Department of Microbiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
  4. 4Sydney Children’s Hospital Network, NSW Pregnancy and Newborn Services, Randwick, New South Wales, Australia
  5. 5National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, School of Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
  6. 6Department of Neonatology, The Canberra Hospital, Garran, Australian Capital Territory, Australia
  7. 7Faculty of Medicine, The Australian National University, Deakin, Australian Capital Territory, Australia
  8. 8Early Start Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
  9. 9Department of Paediatrics, Wollongong Hospital, Wollongong, New South Wales, Australia
  10. 10Illawarra Health and Medical Research Institute and School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
  11. 11School of Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
  1. Correspondence to Dr Kee Thai Yeo, Department of Neonatology, KK Women’s & Children’s Hospital, Singapore 229899, Singapore; yeo.kee.thai{at}singhealth.com.sg

Abstract

Objective To describe the risk of death and hospitalisation until adolescence of children after group B streptococcus (GBS) infection during infancy.

Design Population-based cohort study.

Setting New South Wales, Australia.

Patients All registered live births from 2000 to 2011.

Interventions Comparison of long-term outcomes in children with the International Statistical Classification of Diseases and Related Health Problems-10th Revision discharge codes corresponding to GBS infections and those without.

Main outcome measures Death and hospitalisation.

Results A total of 1206 (0.1%) children (936 (77.6%)≥37 weeks’ gestation) were diagnosed with GBS infection. Over the study period, infection rates decreased from 2.1 (95% CI 1.8 to 2.4) to 0.7 (95% CI 0.5 to 0.9) per 1000 live births. Infants with GBS infection were born at lower gestation (mean 37.6 vs 39.0 weeks), were more likely very low birth weight (<1500 g, OR 9.1(95% CI 7.4 to 11.3)), born premature (OR 3.9(95% CI 3.4 to 4.5)) and have 5 min Apgar scores ≤5 (OR 6.7(95% CI 5.1 to 8.8)). Children with GBS had three times the adjusted odds of death (adjusted OR (AOR) 3.0(95% CI 2.1 to 4.3)) or rehospitalisations (AOR 3.1(95% CI 2.7 to 3.5)). Thirty-six (3.0%) with GBS died, with >50% of deaths occurring <28 days. Children with GBS were hospitalised more frequently (median 2 vs 1), for longer duration (mean 3.7 vs 2.2 days) and were at higher risk for problems with genitourinary (OR 3.1(95% CI 2.8 to 3.5)) and nervous (OR 2.0 (95% CI1.7 to 2.3)) systems.

Conclusions Despite decreasing GBS rates, the risk of poor health outcomes for GBS-infected children remains elevated, especially during the first 5 years. Survivors continue to be at increased risk of death and chronic conditions requiring hospitalisations, such as cerebral palsy and epilepsy.

  • infectious diseases
  • mortality
  • neonatology

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Footnotes

  • Contributors KTY conceived and designed the study, performed the analysis and interpretation of the data, and drafted the initial manuscript. He had full access to all the data in the study and the final responsibility for submission for publication. ML, BB, LH, MEA-L and IMW were involved in the analysis and interpretation of the data, and reviewed and critically revised the manuscript. J-LO conceived and designed the study, obtained ethics approval and linkage data, and reviewed and critically revised the manuscript. All authors approved the paper as submitted and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This project’s ethics approval was obtained as part of a larger project approved by the New South Wales Population and Health Services Research (2012/09/415). This project was also approved by the Aboriginal Health and Medical Research Council (1001/14).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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