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Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury. CHILDREN 2022; 9:children9091321. [PMID: 36138630 PMCID: PMC9497748 DOI: 10.3390/children9091321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
Abstract
Youth with a history of traumatic or non-traumatic acquired brain injury are at increased risk for long-lasting cognitive, emotional, behavioral, social, and physical sequelae post-injury. Such sequelae have great potential to negatively impact this population’s academic functioning. Consistently, poorer academic achievement and elevated need for educational supports have been well-documented among youth with a history of acquired brain injury. The current paper reviews the literature on neuropsychological, psychiatric, and academic outcomes of pediatric acquired brain injury. A discussion of special education law as it applies to this patient population, ongoing limitations within the field, and a proposal of solutions are also included.
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Wang Y, Lei X, Zhao Y, Tan J, Li J, Gong X, Shan L, Zhang Q, Zhou Q, Zhang Y. An improved clinical prediction rule for identifying neonatal bacterial meningitis: a multicenter cohort study. Transl Pediatr 2021; 10:64-72. [PMID: 33633938 PMCID: PMC7882280 DOI: 10.21037/tp-20-255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND To refine the bacterial meningitis (BM) score by improving its predictability of neonatal BM. METHODS A multicenter, ambispective cohort study was conducted in China, comprising 9 hospitals (retrospective cohort: January 2001 to December 2017; prospective cohort: January 2018 to August 2019). Of 3,504 eligible full-term neonates, 475 neonates with cerebrospinal fluid (CSF) pleocytosis were included. Based on the receiver operating characteristic (ROC) curve and logistic regression analyses, the BM score was refined by changing the thresholds of CSF protein level and the CSF absolute neutrophil count (ANC), and removing some variables (the peripheral blood ANC and a history of seizure before or at the time of presentation). RESULTS Of 475 neonates, 94 (19.8%) had BM. Based on the refined BM score, neonates with none of the following high-risk predictors were classified as being at very low risk for BM: CSF protein level ≥1,650 mg/L, CSF ANC ≥84×106 cells/L, and positive CSF Gram stain result. The refined score showed 100% sensitivity in identifying BM and much higher specificity compared to that for the BM score (70.9% vs. 19.4%). CONCLUSIONS The refined BM score effectively identifies neonatal BM, and further studies are required to confirm our findings in prospective studies.
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Affiliation(s)
- Yiwen Wang
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoping Lei
- Department of Neonatology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Youyan Zhao
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jintong Tan
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Li
- Department of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohui Gong
- Department of Neonatology, Children's Hospital of Shanghai, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Liqin Shan
- Department of Neonatology, the Maternal and Child Health Hospital of Jiaxing, Jiaxing, China
| | - Qian Zhang
- Department of Neonatology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qin Zhou
- Department of Neonatology, the Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
| | - Yongjun Zhang
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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School Performance After Pediatric Intensive Care-Association of Mental Well-Being, Chronic Illnesses, and Family Socioeconomic Status. Pediatr Crit Care Med 2020; 21:e1099-e1105. [PMID: 32769702 DOI: 10.1097/pcc.0000000000002564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe school performance in pediatric intensive care survivors, as well as the influence of chronic diseases, psychological well-being, and family socioeconomic status on poor school performance. DESIGN Register-based observational descriptive follow-up study. SETTING A multicenter national study. PATIENTS All pediatric patients who were admitted to an ICU in Finland in 2009-2010. Children and adolescents of or beyond school age. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Questionnaires regarding the child's coping in school classes, chronic illnesses, as well as family socioeconomic factors were sent to every child alive 6 years after discharge from intensive care in Finland. Mental well-being was measured with the Strengths and Difficulties Questionnaire. There were 1,109 responders in an ICU group of 3,674 children. Seven-hundred fifty-three of the respondents were of school age or older. Of these, 13% (101/753) demonstrated poor school performance. Children with difficulties in school more often had a need for regular medication (71.3% vs 32.4%; p < 0.001), healthcare visits (91.1% vs 80.6%; p = 0.01), some regular therapy (60.4% vs 13.7%; p < 0.001), chronic illnesses (86.3% vs 48.4%; p < 0.001), or additional ICU admissions (36.5% vs 14.9%; p = 0.003). Schooling difficulties were reported more often in children with abnormal Strengths and Difficulties Questionnaire scores compared to those with normal or borderline scores (24.8% vs 5.4%; p < 0.001). In an adjusted logistic regression model, which included age, number of chronic diseases, and need for therapy, poor school performance was predicted by abnormal Strengths and Difficulties Questionnaire scores, nonacademic parental education, and paternal manual labor status. CONCLUSIONS Difficulties in school were more frequent when the child had chronic comorbid illnesses, especially neurologic or chromosomal abnormalities, had poor mental health, father was employed in manual labor, or parents were uneducated.
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Pedersen EMJ, Köhler-Forsberg O, Nordentoft M, Christensen RHB, Mortensen PB, Petersen L, Benros ME. Infections of the central nervous system as a risk factor for mental disorders and cognitive impairment: A nationwide register-based study. Brain Behav Immun 2020; 88:668-674. [PMID: 32353515 DOI: 10.1016/j.bbi.2020.04.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/09/2020] [Accepted: 04/26/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND CNS infections have been suggested as risk factors for cognitive decline and mental disorders; however, large-scale studies have been lacking regarding types and agents of CNS infections. METHODS We utilized the unique personal registration number to create a cohort of 1,709,867 individuals born 1977-2010. CNS infection was exposure and data were analysed with 1) cox regression analyses estimating hazard ratios (HR) for developing mental disorders and 2) binomial regression estimating relative risk (RR) for completion of 9th grade including average grade score in a sub-cohort born 1988-1998. RESULTS CNS infection increased the risk for developing mental disorders with a HR of 1.34 (95% CI 1.27-1.42). The highest risk observed was within the first 6 months after the CNS infection with a HR of 26.98 (95% CI 21.19-34.35). Viral CNS infections (HR 1.47, 95% CI 1.35-1.61) conferred a higher risk (p < 0.001) than bacterial (HR 1.24, 95% CI 1.15-1.35). Encephalitis (HR 1.64, 95% CI 1.41-1.90) conferred a higher risk (p < 0.001) than meningitis (HR 1.26, 95% CI 1.18-1.35). The risk was highest for organic mental disorders (HR 6.50, 95% CI 5.11-8.28) and disorders of intellectual development (HR 3.56, 95% CI 2.94-4.31), with a HR of 19.19 (95% CI 7.46-49.35) for profound disorder of intellectual development (IQ < 20). Furthermore, CNS infection decreased the RR of completing 9th grade of mandatory schooling (RR 0.89, 95% CI 0.88-0.91) and lowered average grade score for completers (p < 0.001). CONCLUSIONS CNS infections increased the risk for mental disorders and decreased the likelihood of completing 9th grade, indicating long-term consequences of CNS infections.
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Affiliation(s)
| | - Ole Köhler-Forsberg
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark; Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | | | - Preben B Mortensen
- National Centre for Register-based Research, Aarhus University, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Liselotte Petersen
- National Centre for Register-based Research, Aarhus University, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Michael E Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark; National Centre for Register-based Research, Aarhus University, Denmark; Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Svendsen MB, Ring Kofoed I, Nielsen H, Schønheyder HC, Bodilsen J. Neurological sequelae remain frequent after bacterial meningitis in children. Acta Paediatr 2020; 109:361-367. [PMID: 31325195 DOI: 10.1111/apa.14942] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/30/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
AIM To examine the incidence, clinical presentation and risk factors for neurological sequelae following childhood community-acquired bacterial meningitis (CABM). METHODS We included all children aged 1 month to 15 years old with CABM in North Denmark Region, 1998-2016. Using medical records, we registered baseline demographics, signs and symptoms at admission, laboratory investigations, and outcome assessed by the Glasgow Outcome Scale (GOS). A GOS score of 1-4 was considered an unfavourable outcome. We used modified Poisson regression to examine predefined risk factors for neurological sequelae among survivors. RESULTS We identified 88 cases of CABM in 86 patients (45 female) with a median age of 1.4 years (interquartile range 0.7-4.6). Neisseria meningitidis was the most common pathogen (48/88). Neurological sequelae occurred in 23 (27%) as hearing deficits in 13 (15%), cognitive impairment in 10 (12%) and motor or sensory nerve deficits in 8 (9%). Unfavourable outcome was observed in 16 (18%) patients and three (3%) patients died. Abnormalities on cranial imaging remained the only independent risk factor for developing neurological sequelae in adjusted analysis. CONCLUSION Neurological sequelae following CABM in children remain frequent and abnormal cranial imaging may be an independent risk factor.
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Affiliation(s)
- Morten B. Svendsen
- Department of Infectious Diseases Aalborg University Hospital Aalborg Denmark
| | - Inge Ring Kofoed
- Department of Paediatrics Aalborg University Hospital Aalborg Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Department of Clinical Microbiology Aalborg University Hospital Aalborg Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases Aalborg University Hospital Aalborg Denmark
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Watson RS, Choong K, Colville G, Crow S, Dervan LA, Hopkins RO, Knoester H, Pollack MM, Rennick J, Curley MAQ. Life after Critical Illness in Children-Toward an Understanding of Pediatric Post-intensive Care Syndrome. J Pediatr 2018; 198:16-24. [PMID: 29728304 DOI: 10.1016/j.jpeds.2017.12.084] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/06/2017] [Accepted: 12/28/2017] [Indexed: 12/12/2022]
Affiliation(s)
- R Scott Watson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA; Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
| | - Karen Choong
- Department of Pediatrics and Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Gillian Colville
- Paediatric Psychology Service, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sheri Crow
- Department of Pediatrics and Health Services Research, Mayo Clinic, Rochester, MN
| | - Leslie A Dervan
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
| | - Ramona O Hopkins
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT; Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT; Department of Medicine, Pulmonary & Critical Care Division, Intermountain Medical Center, Murray, UT
| | - Hennie Knoester
- Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Murray M Pollack
- Children's National Health System, George Washington University, Washington, DC
| | - Janet Rennick
- Department of Nursing, Montreal Children's Hospital, Ingram School of Nursing and Department of Pediatrics (Division of Critical Care), Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Martha A Q Curley
- Family and Community Health, School of Nursing, Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Critical Care and Cardiovascular Program, Boston Children's Hospital, Boston, MA
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Bozzola E, Bergonzini P, Bozzola M, Tozzi AE, Masci M, Rossetti C, Carloni E, Villani A. Neuropsychological and internalizing problems in acute central nervous system infections: a 1 year follow-up. Ital J Pediatr 2017; 43:96. [PMID: 29065893 PMCID: PMC5655874 DOI: 10.1186/s13052-017-0416-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background Acute central nervous system (ACNS) infections such as meningitis, encephalitis and cerebellitis still cause morbidity and mortality among children. The aim of this study was to verify whether neuropsychological impairment may develop in ACNS survivors. Methods The study included pediatric patients affected by ACNS disorders, aged 3-16 years admitted to the Bambino Gesù Children Hospital, Rome from June 2013 till June 2015. The patients and their parents underwent a psychological interview and neuropsychological tests during the first week of hospital admission and 1 year after, during a follow-up control. Wilcoxon signed rank tests for paired data were conducted to verify if the results were statistically importance. Patients underwent a cognitive profile test through the Leiter international performance scale – revised, motor skills evaluation through the test of visual-motor integration and a psychopathological evaluation by the child behavior checklist. The K-SADS-PL test was administered in children 6-11 years old to check psychopathological disorders. Results Forty-four patients were included in the study. At the 1 year follow-up, “anxiety problems” (dependency, fears, worries, nervousness) developed in 47% of patients, “somatic problems” (aches, headaches, nausea, vomiting) in 29% and “affective problems” (crying, self-harming, worthlessness, guilt, tiredness, sadness) in 29%. Visual perception was statistically increased at the 1 year follow-up in our patient cohort (p = 0.0297), mainly among the meningitides group (p = 0.0189). Motor-coordination also increased at the follow-up check in the study participants (p = 0.0076), especially in the group affected by cerebellitis (p = 0.0302). Conclusions Neuropsychological disorders are often difficult to recognize in the early stage. They must, however, be promptly identified through specific and standardized neuropsychological examinations in order to avoid long term sequelae in adulthood.
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Affiliation(s)
- Elena Bozzola
- Pediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy.
| | - Paola Bergonzini
- Pediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Mauro Bozzola
- Internal Medicine and Therapeutics Department, Pediatrics and Adolescentology Unit, University of Pavia, Fondazione IRCCS San Matteo, Pavia, Italy
| | | | - Marco Masci
- Pediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Chiara Rossetti
- Pediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Emanuela Carloni
- Sanitary Direction, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Alberto Villani
- Pediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy
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Reshi Z, Nazir M, Wani W, Malik M, Iqbal J, Wajid S. Cerebrospinal fluid procalcitonin as a biomarker of bacterial meningitis in neonates. J Perinatol 2017; 37:927-931. [PMID: 28541274 DOI: 10.1038/jp.2017.73] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/31/2017] [Accepted: 04/17/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The objective of the study was to study the performance of cerebrospinal fluid (CSF) procalcitonin as a marker for bacterial meningitis in neonates, and to determine its optimal 'cutoff' in CSF that can be called significant for the diagnosis. STUDY DESIGN Neonates qualifying for lumbar puncture were prospectively studied. Procalcitonin and established CSF parameters were recorded. RESULTS At a cut-off value of 0.33 ng ml-1, CSF procalcitonin had a sensitivity of 0.92, specificity of 0.87, with positive and negative likelihood ratios of 7.13 and 0.092, respectively. The area under the curve for different CSF parameters was: 0.926 (0.887 to 0.964) (P<0.001) for procalcitonin, 0.965 (0.956 to 0.974) for total leukocyte count, 0.961 (0.94 to 0.983) for neutrophil count, 0.874 (0.825 to 0.923) for protein, 0.946 (0.914 to 0.978) for sugar and 0.92 (0.955 to 0.992) for CSF:serum sugar ratio. The lumbar puncture was traumatic in 36 (21.4%) patients; out of these 15 (41.7%) had bacterial meningitis and 21 (58.3%) had no meningitis. In traumatic lumbar tap group, the median (IQR) CSF procalcitonin in patients with and without meningitis was 1.41 (0.32-3.42) ng/ml and 0.21(0.20-0.31) ng/ml respectively (p<0.05). CONCLUSIONS Procalcitonin measurement has diagnostic efficiency similar to the established CSF markers. Routine assessment of procalcitonin in clean non-contaminated CSF may not yield additional information, but it may have clinical utility in situations where diagnosis of meningitis is in dilemma, as in the case of blood contamination of CSF in traumatic lumbar punctures.
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Affiliation(s)
- Z Reshi
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
| | - M Nazir
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
| | - W Wani
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
| | - M Malik
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
| | - J Iqbal
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
| | - S Wajid
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences Hospital, Srinagar, India
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Meningococcal B Vaccination (4CMenB) in Infants and Toddlers. J Immunol Res 2015; 2015:402381. [PMID: 26351647 PMCID: PMC4553319 DOI: 10.1155/2015/402381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/27/2015] [Accepted: 03/03/2015] [Indexed: 01/26/2023] Open
Abstract
Neisseria meningitidis is a Gram-negative pathogen that actively invades its human host and leads to the development of life-threatening pathologies. One of the leading causes of death in the world, N. meningitidis can be responsible for nearly 1,000 new infections per 100,000 subjects during an epidemic period. The bacterial species are classified into 12 serogroups, five of which (A, B, C, W, and Y) cause the majority of meningitides. The three purified protein conjugate vaccines currently available target serogroups A, C, W, and Y. Serogroup B has long been a challenge but the discovery of the complete genome sequence of an MenB strain has allowed the development of a specific four-component vaccine (4CMenB). This review describes the pathogenetic role of N. meningitidis and the recent literature concerning the new meningococcal vaccine.
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Clark LJ, Glennie L, Audrey S, Hickman M, Trotter CL. The health, social and educational needs of children who have survived meningitis and septicaemia: the parents' perspective. BMC Public Health 2013; 13:954. [PMID: 24112360 PMCID: PMC3852620 DOI: 10.1186/1471-2458-13-954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 10/07/2013] [Indexed: 11/29/2022] Open
Abstract
Background Survivors of bacterial meningitis and septicaemia can experience a range of after-effects. There is little published research on the needs and provision of aftercare for children surviving bacterial meningitis and septicaemia. Methods Mixed methods study employing a survey and follow-up interviews with a sample of survey participants recruited from Meningitis Research Foundation’s member database and social media. Results Of 194 eligible survey respondents, 77% reported at least moderate short-term after-effects, and 57% a need for aftercare or support. Most parents reported that their child received a hearing test (98%) and follow-up appointment with a paediatrician (66%). Psychosocial after-effects were most common and the greatest need was for educational support. About half of participants felt their children’s needs for aftercare were met. We conducted interviews with 18 parents. Findings suggest access could be limited by: parents’ inability to navigate systems in place, child’s age, and delayed identification of sequelae. Parents felt a comprehensive explanation of possible after-effects on discharge from hospital was required, and found uncertain prognoses difficult. Good communication between professionals enabled a service tailored to the child’s needs. Conclusions Our study supports the NICE and SIGN guidelines and highlights areas for improvement in the aftercare of these children.
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Affiliation(s)
- Laura J Clark
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Distribution of invasive meningococcal B disease in Italian pediatric population: implications for vaccination timing. Vaccine 2013; 32:1187-91. [PMID: 24120548 DOI: 10.1016/j.vaccine.2013.09.055] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/16/2013] [Accepted: 09/24/2013] [Indexed: 11/23/2022]
Abstract
Neisseria meningitidis group B (MenB) is a leading cause of meningitis and sepsis. A new vaccine has been recently licensed. The aim of the present study was to evaluate the epidemiology of MenB disease in pediatric age and define the optimal age for vaccination. All patients aged 0-18 years admitted with a diagnosis of meningitis or sepsis to the 83 participating Italian pediatric hospitals were included in the study. Blood and/or cerebrospinal fluid (CSF) samples were tested by Realtime-PCR and/or culture. One hundred and thirty-six cases (mean age 5.0 years, median 2.7) of MenB disease were found. Among these, 96/136 (70.6%) were between 0 and 5 years, 61/136 (44.9%) were between 0 and 2 years. Among the latter, 39/61 (63.9%) occurred during the first year of life with highest incidence between 4 and 8 months. A case-fatality rate of 13.2% was found, with 27.8% cases below 12 months. Sepsis lethality was 24.4%. RT-PCR was significantly more sensitive than culture: 82 patients were tested at the same time by both methods, either in blood or in CSF; MenB was found by RT-PCR in blood or CSF in 81/82 cases (98.8%), culture identified 27/82 (32.9%) infections (Cohen's Kappa 0.3; McNemar's: p<10⁻⁵). The study shows that the highest incidence of disease occurs in the first year of age, with a peak between 4 and 8 months of life; 30% of deaths occur before 12 months. The results suggest that the greatest prevention could be obtained starting MenB vaccination in the first months of life; a catch-up strategy up to the fifth year of life could be considered. Our results also confirm that Realtime PCR is significantly more sensitive than culture. In those countries where only isolate positive infections are counted as cases, the incidence of MenB infection results highly underestimated.
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Neuropsychologic function three to six months following admission to the PICU with meningoencephalitis, sepsis, and other disorders: a prospective study of school-aged children. Crit Care Med 2013; 41:1094-103. [PMID: 23385103 DOI: 10.1097/ccm.0b013e318275d032] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess short-term neuropsychological function and academic performance in school children following admission to intensive care and to explore the role of critical neurologic and systemic infection. DESIGN A prospective observational case-control study. SETTING Two PICUs. SUBJECTS A consecutive sample of 88 children aged 5-16 years (median age=10.00, interquartile range=6.00-13.00) who were admitted to intensive care between 2007 and 2010 with meningoencephalitis, septic illness, or other critical illnesses. They were assessed 3 to 6 months following discharge, and their performance was compared with that of 100 healthy controls. Patients were without prior neurologic or neurodevelopmental disorder. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data encompassing demographic and critical illness details were obtained, and children were assessed using tests of intellectual function, memory, and attention. Questionnaires addressing academic performance were returned by teachers. After adjusting for covariates, the children admitted to PICUs significantly underperformed on neuropsychological measures in comparison to healthy controls (p<0.02). Teachers deemed more children admitted to PICUs than controls as performing educationally worse and having problems with school work (ps=0.001), as well as performing below average on aspects of executive function and attention (ps<0.04). Analysis of the effect of illness type on outcome revealed that aspects of neuropsychological function, such as memory function, and teacher-rated academic performance were most reduced in children with meningoencephalitis and septic illness. In the PICU group, multivariable linear regression revealed that worse performance on a composite score of neuropsychologic impairment was more prevalent when children were younger, from a lower social class, and had experienced seizures during their admission (ps<0.02). CONCLUSIONS Admission to intensive care is followed by deficits in neuropsychologic performance and educational difficulties, with more severe difficulties noted following meningoencephalitis and septic illness. These results highlight the importance of future studies on cognition and educational outcome incorporating type of illness as a moderating factor.
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Park JW, Suh GI, Shin HE. Association between cerebrospinal fluid S100B protein and neuronal damage in patients with central nervous system infections. Yonsei Med J 2013; 54:567-71. [PMID: 23549797 PMCID: PMC3635651 DOI: 10.3349/ymj.2013.54.3.567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE S100B protein is widely used as a measure of glial activity or damage in several brain conditions. Central nervous system (CNS) infections can cause neurological sequelae because of parenchyma invasion. It is difficult to predict further neuronal damage in the CNS infection. The present study is aimed to evaluate the role of the cerebrospinal fluid (CSF) S100B protein as an indicator of neuronal damage in CNS infection. MATERIALS AND METHODS We measured the concentration of CSF S100B protein in 62 patients with a CNS infection using an Enzyme-Linked Immunosorbent Assay. The patients with CNS infections were classified as having no neuronal damage (CNS-N) or as having neuronal damage (CNS+N) according to the presence of neurological change or structural lesions on brain MRI. RESULTS The CSF S100B protein level of the CNS+N group (n=22, 0.235 μg/L, 0.10-2.18) was significantly higher than that of the CNS-N group (n=40, 0.087 μg/L, 0.06-0.12) and control group (n=40, 0.109 μg/L, 0.07-0.14, p<0.01). Using an arbitrary cut off value, S100B-positive CSF was detected in 2.5% of the CNS-N group and in 50% of the CNS+N group (p<0.05). CONCLUSION These findings suggest that increased S100B protein levels in the CSF may be associated with the neuronal damage following CNS infections.
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Affiliation(s)
- Jeong-Wook Park
- Department of Neurology, The Catholic University of Korea College of Medicine, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Gyoung Im Suh
- Department of Neurology, The Catholic University of Korea College of Medicine, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Hae-Eun Shin
- Department of Neurology, The Catholic University of Korea College of Medicine, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
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Johnson S, Marlow N, Wolke D. Assessing educational outcomes in middle childhood: validation of the Teacher Academic Attainment Scale. Dev Med Child Neurol 2012; 54:544-51. [PMID: 22458287 DOI: 10.1111/j.1469-8749.2012.04264.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Assessing educational outcomes in high-risk populations is crucial for defining long-term outcomes. As standardized tests are costly and time-consuming, we assessed the use of the Teacher Academic Attainment Scale (TAAS) as an outcome measure. METHOD Three hundred and forty three children in mainstream schools aged 10 to 11 years (144 males, 199 females; 190 extremely preterm and 153 term; mean age 10 y 9 mo, SD 5.5 mo, range 9 y 8 mo-12 y 3 mo) were assessed using the reading and mathematics scales of the criterion standard Wechsler Individual Achievement Test, 2nd (UK) edition (WIAT-II). Class teachers completed the TAAS, a seven-item questionnaire for assessing academic attainment. The TAAS was also completed at 6 years of age for 266 children. RESULTS Cronbach's alpha 0.95 indicated excellent internal consistency, and the correlation between TAAS scores at 6 and 11 years indicated good test-retest reliability (r=0.77, p<0.001). Significantly higher TAAS scores for term vs preterm children demonstrated discriminative validity. TAAS scores at 6 and 11 years were significantly correlated with WIAT-II reading (r=0.69 and 0.75, p<0.001) and mathematics (r=0.75 and 0.82, p<0.001) scores, demonstrating good predictive and concurrent validity respectively. TAAS scores of <2.5 were good predictors of learning difficulties. INTERPRETATION The TAAS is a brief, psychometrically sound teacher-report of academic attainment that yields continuous and categorical outcomes. It provides a cost- and time-efficient outcome measure for large-scale studies.
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Affiliation(s)
- Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Davie S, Glennie L, Rowland K. Towards a meningitis free world--can we eliminate meningococcal meningitis?: contribution of the meningitis patient groups. Vaccine 2012; 30 Suppl 2:B98-B105. [PMID: 22607905 DOI: 10.1016/j.vaccine.2011.12.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 12/21/2011] [Accepted: 12/22/2011] [Indexed: 10/28/2022]
Abstract
Patient groups play a critical part in the fight against meningitis in all its forms. The UK has the world's three largest meningitis patient groups, which over the past 3 decades have worked tirelessly in the fight against meningitis. Within the UK, where the patient groups work to prevent or alleviate the suffering caused by meningitis and septicaemia, their work is in three areas: continued research; demonstrating burden; and awareness-raising and advocacy. The research relates to developing and improving vaccines, and to improving outcomes for forms of meningitis that are not vaccine preventable. Demonstrating burden - showing the real impact of meningitis from a human perspective - highlights the need for vaccines to prevent the disease. Lives are saved by raising awareness of signs and symptoms and of the need for fast action, whilst advocacy can bring about change to improve the quality of life of those affected by meningitis. Awareness raising and advocacy also have the wider benefit of creating a climate in which people recognise the need for vaccines to prevent this dreadful disease. In addition, the patient groups seek to influence the early introduction and uptake of vaccines as they are licensed and approved by the expert bodies, the UK body being the Joint Committee for Vaccination and Immunisation (JCVI). Each area of activity is explored, and examples given from each of the patient groups of work they have done or are doing in that area.
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Affiliation(s)
- Sue Davie
- Meningitis Trust, Fern House, Bath Road, Stroud, Gloucestershire GL5 3TJ, UK.
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Sellner J, Täuber MG, Leib SL. Pathogenesis and pathophysiology of bacterial CNS infections. HANDBOOK OF CLINICAL NEUROLOGY 2010; 96:1-16. [PMID: 20109671 DOI: 10.1016/s0072-9752(09)96001-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Johann Sellner
- Department of Neurology, Technische Universität München, Germany
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Howitz M, Christiansen AH, Harboe ZB, Mølbak K. Surveillance of bacterial meningitis in children under 2 y of age in Denmark, 1997–2006. ACTA ACUST UNITED AC 2009; 40:881-7. [DOI: 10.1080/00365540802325914] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
PURPOSE OF REVIEW Distinguishing between bacterial and aseptic meningitis in children is sometimes difficult. Guidelines recommend that patients with acute meningitis be systematically hospitalized and treated with antibiotics until the cerebrospinal fluid culture results are available. This strategy ensures rapid treatment for bacterial meningitis, but also involves unnecessary admissions and antibiotics for aseptic meningitis. Some authors have, therefore, proposed different combinations of predictors in clinical decision rules to distinguish as early as possible between bacterial and aseptic meningitis. To be useful, these rules must have near-100% sensitivity for bacterial meningitis, good specificity (to reduce unnecessary antibiotics and admissions), and easy bedside application. RECENT FINDINGS The present review examines the performance and level of validation of decision rules proposed after the Haemophilus influenzae vaccination entered widespread use. Most of these rules have been validated incompletely, if at all. Only one rule incorporates the best single validated predictive marker for distinguishing between bacterial and aseptic meningitis in children: serum procalcitonin level. SUMMARY Two rules are highly promising, meeting the three major conditions after a retrospective validation process in large samples. These rules can be applied cautiously to patients with the same inclusion and exclusion criteria as those in the derivation sets, while awaiting prospective multicenter validation studies.
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Dubos F. Stratégie de prise en charge (diagnostic, surveillance, suivi) d’une méningite présumée bactérienne de l’enfant. Med Mal Infect 2009; 39:615-28. [DOI: 10.1016/j.medmal.2009.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
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Skoe Ø, Døllner H. Bakteriell meningitt hos barn i Sør-Trøndelag 1988 – 2007. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:851-4. [DOI: 10.4045/tidsskr.08.0115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Ritchi L, Jennekens-Schinkel A, van Schooneveld M, Koomen I, Geenen R. Behaviour is not really at risk after surviving meningitis in childhood. Acta Paediatr 2008; 97:438-41. [PMID: 18307551 DOI: 10.1111/j.1651-2227.2008.00682.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To examine behaviour problems, personality, self-perceived competence and academic deficits in children who had recovered from non-Haemophilus influenzae type b (Hib) bacterial meningitis (BM) without obvious medical sequelae. METHODS Assessments in 182 children, mean age 10 (range 5-14) years, 4-10 years after surviving meningitis, were compared to scores of norm reference groups. RESULTS More children were estimated to have academic deficits (27%) than behaviour problems as perceived by the parents (9%). The mean deviation from normal was absent to moderate on behaviour problems, personality variables and self-perceived competence. CONCLUSION Children who survived non-Hib BM without severe medical sequelae hardly differ from normal children with respect to personality and self-perceived competence. A small proportion deviates from normal in behaviour problems.
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Affiliation(s)
- Lieneke Ritchi
- Sector of Neuropsychology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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