Koomen I, Grobbee D E, Jennekens-Schinkel A, Roord J J, van Furth A M
Department of Paediatrics, VU Medical Centre, Amsterdam, The Netherlands.
Acta Paediatr. 2003;92(2):177-85. doi: 10.1111/j.1651-2227.2003.tb00523.x.
To determine the occurrence of educational, behavioural and general health problems in Dutch school-age survivors of bacterial meningitis.
A cohort of 680 school-age survivors of meningitis caused by the most common Gram-positive and Gram-negative bacteria was established approximately 6y after the children's illness. Children with Haemophilus influenzae type b (Hib) meningitis were excluded because this form of the disease has virtually disappeared. Parents completed questionnaires on educational, behavioural and general health problems. The reference group comprised 304 school-age siblings and peers.
Postmeningitic children were more likely than controls to under achieve at school: 20% vs 5% (odds ratio 5.6; 95% confidence interval 3.0-10.7). The postmeningitic children repeated a year twice as often as the children in the reference group (16% vs 8%, odds ratio: 2.5, 95% confidence interval 1.5-4.2) and were referred to a special-needs school four times more frequently (8% vs 2%, odds ratio: 5.5; 95% confidence interval 2.0-15.4). Parents also reported more behavioural problems at home. More than half of the postmeningitic children experienced general health problems. The causative pathogen or age at infection had no influence on the relative frequency of educational and behavioural problems, and reduced auditory functioning played only a small part in these problems.
Parents perceive educational, behavioural and general health problems in more than 30% of postmeningitic children. Until it is clear which children are at highest risk of developing these problems, it will be necessary to follow postmeningitic children into their school-age years.
确定荷兰细菌性脑膜炎学龄期幸存者中教育、行为和一般健康问题的发生率。
在儿童患病约6年后,建立了一个由680名由最常见的革兰氏阳性和革兰氏阴性细菌引起的脑膜炎学龄期幸存者组成的队列。b型流感嗜血杆菌(Hib)脑膜炎患儿被排除在外,因为这种疾病形式实际上已消失。家长完成了关于教育、行为和一般健康问题的问卷。参照组包括304名学龄期兄弟姐妹和同龄人。
患脑膜炎后的儿童在学业上成绩不达标的可能性高于对照组:分别为20%和5%(优势比5.6;95%置信区间3.0 - 10.7)。患脑膜炎后的儿童留级的频率是参照组儿童的两倍(分别为16%和8%,优势比:2.5,95%置信区间1.5 - 4.2),被转至特殊需求学校的频率高出四倍(分别为8%和2%,优势比:5.5;95%置信区间2.0 - 15.4)。家长还报告说他们在家中有更多行为问题。超过一半的患脑膜炎后的儿童有一般健康问题。致病病原体或感染时的年龄对教育和行为问题的相对发生率没有影响,听力功能下降在这些问题中只起了很小的作用。
超过30%的患脑膜炎后的儿童家长察觉到孩子存在教育、行为和一般健康问题。在明确哪些儿童发生这些问题的风险最高之前,有必要对患脑膜炎后的儿童进行学龄期随访。