Neurodevelopmental outcomes and neuroimaging findings in five children with early newborn sepsis and meningoencephalitis caused by group B streptococcus

Abstract

The aim is to present fi ve patients who had newborn sepsis and meningoencephalitis caused by group B streptococcus, with emphasis on their perinatal risk factors, neuroimaging fi ndings (ultrasound, magnetic resonance) and neurodevelopmental outcomes. Data were obtained retrospectively for the 2008-2011 period from archives of the Zagreb Children’s Hospital, Department of Neuropediatrics. All patients were born at term. Two mothers were febrile during labor and one received amoxicillin with clavulanic acid. Data on maternal group B streptococcus status during pregnancy or information on the administration of intrapartal antibiotic prophylaxis were unavailable in four cases. Two patients had mild neurodevelopment impairment presenting either as impairment of speech or motor development, with corresponding neuroimaging fi nding of enlargement of the ventricles and subarachnoid spaces or leukomalation with cystic lesions in frontal regions. Three patients had severe multiple neurodevelopment impairments; two of them had associated vision impairment, epilepsy and hydrocephalus with ventriculoperitoneal shunting, while the patient with a worse outcome also had hearing impairment. Neuroimaging fi ndings of these patients showed areas of leukomalacia with numerous cystic lesions, mostly localized in telencephalon, accompanied by various degrees of ventricle enlargement and corpus callosum thinning. In conclusion, neuroimaging fi ndings revealed destructive brain lesions with predilection for telencephalic region. Early newborn sepsis with meningoencephalitis caused by group B streptococcus has unfavorable outcome in term newborns; three out of fi ve patients had severe multiple neurodevelopmental impairment. Since this disease can be eff ectively prevented, there is a need to establish and implement a national prevention strategy.