Incidence of invasive Group B Streptococcal infection and the risk of infant death and cerebral palsy: a Norwegian Cohort Study

Maren Mynarek,Solveig Bjellmo,Stian Lydersen,Torstein Vik,Jan E Afset,Guro L Andersen

doi:10.1038/s41390-020-1092-2

Abstract

BackgroundGroup B Streptococcus (GBS) is the leading cause of invasive neonatal infection worldwide. In high-income countries mortality rates are 4–10%, and among survivors of GBS meningitis 30–50% have neurodevelopmental impairments. We hypothesized that invasive GBS infection was associated with increased risk of infant mortality and cerebral palsy (CP).MethodsAll children born alive in Norway during 1996–2012 were included. Data were collected from three national registers. Invasive GBS infection during infancy was categorized into early-onset disease (EOD), late-onset disease (LOD), and very late-onset disease (VLOD). Primary outcomes were infant mortality and CP.ResultsInvasive GBS infection was diagnosed in 625 children (incidence: 0.62 per 1000 live births; 95% confidence interval (CI): 0.57–0.67). The incidence of EOD was 0.41 (0.37–0.45), of LOD 0.20 (0.17–0.23), and of VLOD 0.012 (0.007–0.021). The annual incidence of LOD increased slightly. Among infected infants, 44 (7%) died (odds ratio (OR): 24.5; 95% CI: 18.0–33.3 compared with the background population). Among survivors, 24 (4.1%) children were later diagnosed with CP, compared with 1887 (0.19%) in the background population (OR: 22.9; 95% CI: 15.1–34.5).ConclusionDespite a relatively low incidence of invasive GBS infection in Norway, the risk of death and CP remains high. Improvements in prevention strategies are needed.ImpactDuring the first decade of the twenty-first century, invasive GBS disease in infancy is still associated with high mortality.Despite the overall low incidence of invasive GBS disease, the incidence of LOD increased during the study period.The finding that invasive GBS infection in the neonatal period or during infancy is associated with an excess risk of CP, comparable to the risk following moderate preterm birth and moderate low Apgar scores, adds to the existing literature.The results of this study emphasize the importance of adhering to guidelines and the need for better prevention strategies.

Highlights

Streptococcus agalactiae (Group B streptococcus, Group B Streptococcus (GBS)) remains a leading cause of invasive infection in neonates [1]
Invasive GBS infection was diagnosed in 625 children (Incidence: 0.62 per 1000 livebirths; 95% confidence interval (CI): 0.57-0.67)
Information on GBS disease was retrieved from the Norwegian Surveillance System for Communicable Diseases (MSIS) and combined with information from The Medical Birth Registry of Norway (MBRN) regarding maternal health before and during pregnancy, the course of the delivery and newborn health, as well as with neurodevelopmental information retrieved from The Cerebral Palsy Registry of Norway (CPRN)

Summary

Introduction

Streptococcus agalactiae (Group B streptococcus, GBS) remains a leading cause of invasive infection in neonates [1]. Despite improvements in maternal and perinatal care, GBS infection is still associated with substantial mortality and morbidity [2, 3]. Invasive infection presenting within the first seven days of life is classified as early onset disease (i.e. EOD), while infection presenting between seven and 89 days of life is classified as late onset (i.e. LOD). One to two percent of these children will develop invasive GBS infection [4]. Streptococcus (GBS) is the worldwide leading cause of invasive neonatal infection. We hypothesized that invasive GBS infection was associated with increased risk of infant mortality and cerebral palsy (CP). Invasive GBS infection during infancy was categorized into early onset disease (EOD), late onset (LOD) and very late onset disease (VLOD).

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