Meningitis-related hearing loss can impair posturomotor development in infants
MedWire News: Bacterial-meningitis induced vestibular impairment can trigger postural instability and delayed posturomotor development in infants, especially if the infection occurs before they are walking independently, suggest results published in the Journal of Pediatrics.
"Postural instability following the acute phase of meningitis is usually considered to be a consequence of extreme fatigability related to recovery from a severe general infection or from undefined neurologic impairments," explain Sylvette Wiener-Vacher (Hopital Pediatrique Robert Debré, Paris, France) and colleagues.
Although some previous studies have suggested that postural instability could be a consequence of vestibular impairment, none have evaluated the consequences of partial and complete vestibular loss on posturomotor development in infantile meningitis, say the authors.
To investigate further, Wiener-Vacher and team followed-up 37 children hospitalized for bacterial meningitis who were aged a median of 2.3 years (youngest 1.5 months) when they contracted the infection. The children were referred for postural instability evaluation a median of 7 months after meningitis onset.
In total, 18 children had meningitis before independent walking age (IWA) and 19 had meningitis after being able to walk independently. Three children had severe neurologic deficits after meningitis and were excluded from further analysis to avoid confounding.
Most of the remaining neurologically normal children had some level of vestibular impairment as a result of their infection. Fifteen had complete bilateral vestibular impairment (five pre-; ten post-IWA), 13 had partial (four pre-; seven post-IWA), and eight had normal (six pre-; two post-IWA) vestibular function.
The investigators found that children who had meningitis pre-IWA and who had complete bilateral vestibular impairment walked significantly later than the other children (22.0 months vs 12.0-17.5 months) and had a longer duration of postural instability (18.8 months vs <2 days-2.6 months).
In addition, the duration of postural instability seemed to correlate with the degree of vestibular impairment, such that children with partial impairment had durations of instability intermediate to those of children with normal vestibular function and children with complete bilateral impairment.
"Vestibular loss after meningitis is sufficiently frequent (10.5%) to argue for its screening after pediatric bacterial meningitis to reduce or exclude the presumption of an undefined neurologic origin for certain post-meningitis psychomotor disorders, and hence lead to the choice of appropriate physical therapies," write the authors.
"Early adapted physical therapy can reduce the developmental consequences of decreased vestibular function and help children to overcome this handicap more rapidly," they conclude.
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By Helen Albert