ADVERSE OUTCOMES OF BACTERIAL-MENINGITIS IN SCHOOL-AGE SURVIVORS

Objective. To determine the outcomes of bacterial meningitis in school -age survivors. Design. Prospective cohort study. Setting. Teaching pe diatric hospital. Children. During 1983 through 1986, 158 meningitis s urvivors, ages 3 months to 14 years, treated at a single center were e nrolled. Between 1991 and 1993, 130 children, 82% of the original coho rt, were evaluated at a mean age of 8.4 years and a mean of 6.7 years after their meningitis. Outcome measures. Blinded neurologic, neuropsy chologic, audiologic, behavior, and socio-demographic assessments were compared with those from grade- and sex-matched control children. Mul tivariate analyses adjusted for age at testing and socio-demographic v ariables. Results. There was a systematic increase in risk of abnormal ity or poorer functioning for children with meningitis, compared with control children, across all categories tested, which was significant for fine motor function, Intelligence quotient (IQ) scores, and tests of school behavior, neuropsychologic function, and auditory figure-gro und differentiation. Eleven children who had experienced meningitis (8 .5%) had major deficits (IQ <70, seizures, hydrocephalus, spasticity, blindness, or severe to profound hearing loss); a further 24 (18.5%) c ases and 14 (10.8%) control children had minor deficits (IQ 70 to 80, inability to read, mild to moderate hearing loss, abnormalities in spe ech discrimination, or school behavior problems). Overall, children wh o had meningitis were at greater risk (26.9%) for disability. Children with acute neurologic complications had more adverse outcomes than th ose with uncomplicated meningitis and control children (39% vs 18% vs 11%, respectively). Conclusions. One in four school-age meningitis sur vivors has either serious and disabling sequelae or a functionally imp ortant behavior disorder, neuropsychologic or auditory dysfunction adv ersely affecting academic performance. As a group, survivors function less well than their classroom peers, and risk is greatest for, but no t confined to, those who had acute neurologic complications. All survi vors require careful follow-up, at least until school age.