PROSPECTIVE STUDY OF THE OUTCOME OF ASEPTIC MENINGITIS

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The long term prognosis of aseptic meningitis is generally thought to be benign. This presumption has been challenged recently by several retrospective studies which have suggested that as many as 16% of children who have enteroviral meningitis as young infants suffer significant neurological sequelae. Conclusions from these studies are limited by retrospective study design, criticism regarding control selection, and by small numbers of subjects. Discharge diagnosis data from hospitals in Maryland show that the rate of clinically recognized aseptic meningitis in infants under 12 months of age is more than 10-fold higher than for any other age group. Thus, aseptic meningitis has the highest attack rate in the age group that is most likely to suffer adverse neurological sequelae as a result of an inflammary insult occurring during a critical period of CNS development. This study is designed to assess potential neurological sequelae by prospectively following approximately 136 children who are admitted to one of three hospitals in Baltimore with aseptic meningitis between 8/1/85 and 10/31/89. Aseptic meningitis cases are to be enrolled during hospitalization for acute illness. Immediately following enrollment, 2 children will be selected as controls from the population of children residing in Baltimore who were born at the hospital where the index case has been admitted. Control children are to be matched with the index case for age, sex, race, socioeconomic status and educational opportunity. Study patients and controls will be asked to return for evaluation 4-5 weeks after discharge of the study patient, and when they reach 18 months, 30 months and 42 months of age. At each return visit, both patients and controls will be given neurological examinations and the Bayley Scale for Infant Development (BSID) will be administered at the one month follow-up, and 30 months of age; the Kaufman Assessment Battery for Children (KABC) will be used at 30 months and 42 months of age. The results of these evaluations will be compared for the cohort of study patients and the control cohort at each examination. The sample size, adjusted for anticipated drop-out, will be sufficient to detect a difference of 0.5 standard deviation on either test with a power ranging from 88% to 98% for the entire study sample. There will also be sufficient power to analyze the effect of age of patient, sex, race, socioeconomic status, enterovirus etiology, and severity of original infection on the long-term outcome of aseptic meningitis. If this study fails to demonstrate a significant effect on neurodevelopmental function, then infants with aseptic meningitis can be given an unequivocally good prognosis. If effects are demonstrated, then these data may stimulate efforts to prevent aseptic meningitis in young infants.