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Among infants diagnosed with late-onset GBS meningitis, does adjunctive dexamethasone therapy, compared to antibiotic therapy alone, lead to improved neurologic outcomes and reduced long-term complications?

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Infection by gram (+) diplococci that colonizes GU/GI tract that occurs around 4-5 weeks of age --> GBS passed to babies vertically or horizontally

Incidence: Late onset GBS 0.2-0.4/1000 births since 1990

Prevention: Not prevented by materal intrapartum prophylaxis

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-Baseline: LP, Urine Culture, Blood Culture

-Late-onset GBS suspicion: CBC w/ diff, inflammatory markers, electrolytes, coagulation tests

-Neuroimaging

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-For confirmed GBS meningitis: Penicillin G or Ampicillin

-If dexamethasone is given, it should be administered before, or immediately after, the first dose of antibiotic therapy.

-Timing: Varies-10 days IV abx if uncomplicated, all the way up to 4 weeks

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-Short term: Seizures, brain abscess, stroke, and cerebral edema in addition to the imaging demonstrated

-Long term: Developmental delay, motor disability, hearing loss, vision impairment

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A randomized clinical trial with 52 full-term neonates with bacterial meningitis were separated into a control group with standard abx and a group with dexamethasone + abx. 3 subjects had GBS meningitis.

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anti-inflammatory therapy may reduce the risk of neurologic complications by reducing inflammation and cerebral edema

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There was no significant difference in mortality, clinical response, or complications between groups. This topic is not well-researched and the only significant association that has been drawn between neonatal meningitis and dexamethasone is a mild reduction in hearing loss among those who were using it (this is seen best in HiB)

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Physicians are encouraged to use clinical judgement to decide weather they want to add dexamethasone to their patients regimen or not. It is important that they consider the adverse effects including hyperglycemia, behavioral changes, and GI problems and recognize that it is not a well-researched topic.

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Lack of effectiveness of dexamethasone in neonatal bacterial meningitis - PubMed

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Adjunctive dexamethasone therapy does not improve the outcome of neonatal bacterial meningitis.