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Published on: November 21, 2013
Risk of psychiatric neurodevelopmental disorders after meningitis in childhood: a nationwide, population-based cohort
Emma E Graham1, Malte M Tetens1, Jacob Bodilsen2,3
1Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Insights
Childhood bacterial meningitis increases the risk of psychiatric neurodevelopmental disorders (PNDD), particularly in young infants. Enteroviral meningitis does not pose this risk, with prematurity and family factors playing a role.
Area of Science:
- Neuroscience
- Pediatrics
- Infectious Diseases
Background:
- Limited research exists on the long-term risk of psychiatric neurodevelopmental disorders (PNDD) following childhood meningitis.
- Meningitis, an inflammation of the membranes surrounding the brain and spinal cord, can have severe consequences, especially in children.
Purpose of the Study:
- To investigate the association between childhood meningitis (bacterial and enteroviral) and the subsequent risk of PNDD.
- To identify specific PNDD associated with meningitis and explore potential contributing factors like age at infection, prematurity, and familial influences.
Main Methods:
- A nationwide population-based cohort study in Denmark (1995-2021) included children diagnosed with bacterial or enteroviral meningitis.
- Comparison cohorts included the general population and siblings of affected children.
- Hazard ratios (aHRs) were calculated to estimate the risk of PNDD, stratified by age (young infants vs. older children).
Main Results:
- Children with bacterial meningitis showed significantly increased risks of PNDD, including intellectual disabilities and ADHD, especially in young infants.
- Young infants with bacterial meningitis also had higher risks of autism spectrum and behavioral disorders.
- Prematurity was linked to a higher PNDD risk in young infants with bacterial meningitis. Siblings of children with bacterial meningitis also showed increased PNDD risks.
- Enteroviral meningitis was not associated with an increased risk of PNDD or ADHD medication use.
Conclusions:
- Childhood bacterial meningitis is a risk factor for developing PNDD, whereas enteroviral meningitis is not.
- The observed association is partly attributed to prematurity and shared familial or socioeconomic factors.
- These findings highlight the importance of monitoring neurodevelopmental outcomes in children with a history of bacterial meningitis.
Background:
Few studies have investigated the risk of psychiatric neurodevelopmental disorders (PNDD) after childhood meningitis.
Methods:
Nationwide population-based cohort study (Denmark, 1995-2021) of children with positive cerebrospinal fluid for bacteria or enterovirus, stratified on age as young infants (0 to <90 days, n = 637) or older children (≥90 days to <17 years, n = 1,218). We constructed a comparison cohort from the general population (n = 18,550), and cohorts of siblings of participants. As risk estimates of PNDD we calculated age- and sex-adjusted hazard ratios (aHRs) with 95% confidence intervals (95%CI).
Results:
Children with bacterial meningitis had increased risks of PNDD, especially learning and intellectual developmental disorders (young infants: aHR 4.2, 95%CI: 2.4-7.1; older children: aHR 1.5, 95%CI: 1.0-2.3), attention deficit disorder (ADHD) (young infants: aHR 2.8, 95%CI: 1.5-5.2; older children: 1.4, 95%CI: 0.9-2.2) and redemption of ADHD medication (young infants: aHR 2.2, 95%CI: 1.0-4.7; older children: 1.5, 95%CI: 1.0-2.3). Young infants with bacterial meningitis additionally had increased risks of autism spectrum disorders (aHR 1.9, 95%CI: 0.9-4.1) and behavioural and emotional disorders (aHR 2.0, 95%CI: 1.0-3.9). In young infants, the excess risk of PNDD was especially observed in premature children. Siblings of older children with bacterial meningitis also had increased risks of PNDD. Children with enteroviral meningitis at any age did not have increased risks of PNDD or redemption of ADHD medication.
Conclusions:
Bacterial meningitis in childhood is associated with subsequent diagnosis of PNDD, while enteroviral meningitis is not. The association appears to be partly explained by prematurity and familial and socioeconomic factors.
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