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Long-term Outcome of Haemophilus influenzae Meningitis in Navajo Indian Children
Carl T. D'Angio, MD;
Robert G. Froehlke, MD;
Gary A. Plank, PhD;
David J. Meehan, MD;
Christine M. Aguilar, MD;
Marc B. Lande, MD;
Lily Hugar, MA
Arch Pediatr Adolesc Med. 1995;149(9):1001-1008.
Abstract
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Objectives
To determine the long-term neurologic, cognitive, and educational outcomes of Navajo children who survived Haemophilus influenzae type b meningitis.
Design
Retrospective cohort study, with 3.6- to 15.0-year follow-up.
Setting
Navajo Indian reservation.
Participants
Population-based cohort of 76 Navajo children with Haemophilus meningitis at less than 5 years of age between 1975 and 1986, with 41(54%) consenting to undergo follow-up in 1990. Each case was matched to one nearest-age sibling and one unrelated age-matched control.
Main Outcome Measures
Standardized intelligence test scores, neurologic abnormalities, and school performance.
Results
The mean IQ for cases was lower than that for siblings (79 vs 87, P=.006) or age-matched controls (79 vs 95, P<.001). Twenty-nine percent of cases had severe neurologic sequelae, including mental retardation (24%), severe hearing loss (5%), cerebral palsy (7%), and seizure disorder (12%). Eight percent of siblings (relative risk for cases vs siblings, 8.0; P=.05) and 2% of age--matched controls (relative risk vs cases, 10.0; P=.01) had mental retardation. No siblings or age-matched controls had any other severe neurologic sequela. Twenty-nine percent of cases, 23% of siblings (relative risk, 2.5; P=.45), and 0% of age-matched controls (P=.001) required special education services, while 42% of cases, 23% of siblings (relative risk, 3.3; P=.10), and 11% of age-matched controls (relative risk, 4.0; P=.005) had been retained in a grade in school.
Conclusions
Navajo survivors of Haemophilus meningitis suffer more long-term neurologic, cognitive, and school-related disability than siblings or age-matched controls. They may also suffer higher morbidity than Haemophilus meningitis survivors in the general population.
(Arch Pediatr Adolesc Med. 1995;149:1001-1008)
Author Affiliations
From the Department of Pediatrics, University of Rochester (NY) (Dr D'Angio); Department of Pediatrics and Human Development, Michigan State University, East Lansing (Dr Froehlke); Department of Psychology, University of New Mexico, Albuquerque (Dr Plank); the Navajo Area Indian Health Service, Public Health Service (Dr Meehan and Ms Hugar); Department of Rehabilitation Medicine, University of California, Davis (Dr Aguilar); and Department of Pediatrics, Oregon University Health Sciences Center, Portland (Dr Lande).
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