Karen M Puopolo1,2,3, Sagori Mukhopadhyay1,2,3, Nellie I Hansen4, Dustin D Flannery1,2,3, Rachel G Greenberg5, Pablo J Sanchez6, Edward F Bell7, Sara B DeMauro1,2, Myra H Wyckoff8, Eric C Eichenwald1,2, Barbara J Stoll9. 1. Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 2. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. 3. Center for Pediatric Clinical Excellence, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 4. Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina, USA. 5. Department of Pediatrics, Duke University, Durham, North Carolina, USA. 6. Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA. 7. Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA. 8. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 9. Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Abstract
BACKGROUND: This study was performed to determine the incidence of group B Streptococcus (GBS) disease among extremely preterm infants and assess to risk of death or neurodevelopmental impairment (NDI) at a corrected age of 18-26 months. METHODS: In this observational cohort study of infants enrolled in a multicenter registry, the incidence of GBS disease was assessed in infants born in 1998-2016 at 22-28 weeks' gestation and surviving for >12 hours. The composite outcome, death or NDI, was assessed in infants born in 1998-2014 at 22-26 weeks' gestation. Infection was defined as GBS isolation in blood or cerebrospinal fluid culture at ≤72 hours (early-onset disease [EOD]) or >72 hours (late-onset disease [LOD]) after birth. Using Poisson regression models, the outcome was compared in infants with GBS disease, infants infected with other pathogens, and uninfected infants. RESULTS: The incidence of GBS EOD (2.70/1000 births [95% confidence interval (CI), 2.15-3.36]) and LOD (8.47/1000 infants [7.45-9.59]) did not change significantly over time. The adjusted relative risk of death/NDI was higher among infants with GBS EOD than in those with other infections (adjusted relative risk, 1.22 [95% CI, 1.02-1.45]) and uninfected infants (1.44 [1.23-1.69]). Risk of death/NDI did not differ between infants with GBS LOD and comparator groups. GBS LOD occurred at a significantly later age than non-GBS late-onset infection. Among infants surviving >30 days, the risk of death was higher with GBS LOD (adjusted relative risk, 1.90 [95% CI, 1.36-2.67]), compared with uninfected infants. CONCLUSIONS: In a cohort of extremely preterm infants, the incidence of GBS disease did not change during the study period. The increased risk of death or NDI with GBS EOD, and of death among some infants with GBS LOD, supports the need for novel preventive strategies for disease reduction. CLINICAL TRIALS REGISTRATION: NCT00063063.
BACKGROUND: This study was performed to determine the incidence of group B Streptococcus (GBS) disease among extremely preterm infants and assess to risk of death or neurodevelopmental impairment (NDI) at a corrected age of 18-26 months. METHODS: In this observational cohort study of infants enrolled in a multicenter registry, the incidence of GBS disease was assessed in infants born in 1998-2016 at 22-28 weeks' gestation and surviving for >12 hours. The composite outcome, death or NDI, was assessed in infants born in 1998-2014 at 22-26 weeks' gestation. Infection was defined as GBS isolation in blood or cerebrospinal fluid culture at ≤72 hours (early-onset disease [EOD]) or >72 hours (late-onset disease [LOD]) after birth. Using Poisson regression models, the outcome was compared in infants with GBS disease, infants infected with other pathogens, and uninfected infants. RESULTS: The incidence of GBS EOD (2.70/1000 births [95% confidence interval (CI), 2.15-3.36]) and LOD (8.47/1000 infants [7.45-9.59]) did not change significantly over time. The adjusted relative risk of death/NDI was higher among infants with GBS EOD than in those with other infections (adjusted relative risk, 1.22 [95% CI, 1.02-1.45]) and uninfected infants (1.44 [1.23-1.69]). Risk of death/NDI did not differ between infants with GBS LOD and comparator groups. GBS LOD occurred at a significantly later age than non-GBS late-onset infection. Among infants surviving >30 days, the risk of death was higher with GBS LOD (adjusted relative risk, 1.90 [95% CI, 1.36-2.67]), compared with uninfected infants. CONCLUSIONS: In a cohort of extremely preterm infants, the incidence of GBS disease did not change during the study period. The increased risk of death or NDI with GBS EOD, and of death among some infants with GBS LOD, supports the need for novel preventive strategies for disease reduction. CLINICAL TRIALS REGISTRATION: NCT00063063.
Authors: Adam W Bartlett; Ben Smith; C R Robert George; Brendan McMullan; Alison Kesson; Monica M Lahra; Pamela Palasanthiran Journal: Pediatr Infect Dis J Date: 2017-01 Impact factor: 2.129
Authors: Ravi M Patel; Sarah Kandefer; Michele C Walsh; Edward F Bell; Waldemar A Carlo; Abbot R Laptook; Pablo J Sánchez; Seetha Shankaran; Krisa P Van Meurs; M Bethany Ball; Ellen C Hale; Nancy S Newman; Abhik Das; Rosemary D Higgins; Barbara J Stoll Journal: N Engl J Med Date: 2015-01-22 Impact factor: 91.245
Authors: Rachel G Greenberg; Sarah Kandefer; Barbara T Do; P Brian Smith; Barbara J Stoll; Edward F Bell; Waldemar A Carlo; Abbot R Laptook; Pablo J Sánchez; Seetha Shankaran; Krisa P Van Meurs; M Bethany Ball; Ellen C Hale; Nancy S Newman; Abhik Das; Rosemary D Higgins; C Michael Cotten Journal: Pediatr Infect Dis J Date: 2017-08 Impact factor: 3.806
Authors: Barbara J Stoll; Nellie Hansen; Avroy A Fanaroff; Linda L Wright; Waldemar A Carlo; Richard A Ehrenkranz; James A Lemons; Edward F Donovan; Ann R Stark; Jon E Tyson; William Oh; Charles R Bauer; Sheldon B Korones; Seetha Shankaran; Abbot R Laptook; David K Stevenson; Lu-Ann Papile; W Kenneth Poole Journal: Pediatrics Date: 2002-08 Impact factor: 7.124
Authors: Robert J Palisano; Lisa Avery; Jan Willem Gorter; Barbara Galuppi; Sarah Westcott McCoy Journal: Dev Med Child Neurol Date: 2018-05-04 Impact factor: 5.449
Authors: Hannah T Jordan; Monica M Farley; Allen Craig; Janet Mohle-Boetani; Lee H Harrison; Susan Petit; Ruth Lynfield; Ann Thomas; Shelley Zansky; Kenneth Gershman; Bernadette A Albanese; William Schaffner; Stephanie J Schrag Journal: Pediatr Infect Dis J Date: 2008-12 Impact factor: 2.129
Authors: Barbara J Stoll; Nellie Hansen; Avroy A Fanaroff; Linda L Wright; Waldemar A Carlo; Richard A Ehrenkranz; James A Lemons; Edward F Donovan; Ann R Stark; Jon E Tyson; William Oh; Charles R Bauer; Sheldon B Korones; Seetha Shankaran; Abbot R Laptook; David K Stevenson; Lu-Ann Papile; W Kenneth Poole Journal: N Engl J Med Date: 2002-07-25 Impact factor: 91.245
Authors: Barbara J Stoll; Karen M Puopolo; Nellie I Hansen; Pablo J Sánchez; Edward F Bell; Waldemar A Carlo; C Michael Cotten; Carl T D'Angio; S Nadya J Kazzi; Brenda B Poindexter; Krisa P Van Meurs; Ellen C Hale; Monica V Collins; Abhik Das; Carol J Baker; Myra H Wyckoff; Bradley A Yoder; Kristi L Watterberg; Michele C Walsh; Uday Devaskar; Abbot R Laptook; Gregory M Sokol; Stephanie J Schrag; Rosemary D Higgins Journal: JAMA Pediatr Date: 2020-07-06 Impact factor: 16.193