Influenza-Associated Neurologic Complications in Children

Abstract

Research Article| October 01 2021 Influenza-Associated Neurologic Complications in Children AAP Grand Rounds (2021) 46 (4): 39. https://doi.org/10.1542/gr.46-4-39 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Influenza-Associated Neurologic Complications in Children. AAP Grand Rounds October 2021; 46 (4): 39. https://doi.org/10.1542/gr.46-4-39 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: influenza, neurologic complications Source: Antoon JW, Hall M, Herndon A, et al Prevalence, risk factors, and outcomes of influenza-associated neurologic complications in children [published online ahead of print June 30, 2021]. J Pediatr. doi:10.1016/j.jpeds.2021.06.075 Investigators from multiple institutions conducted a retrospective study to estimate the prevalence of neurologic complications in children hospitalized with influenza, identify risk factors associated with these complications, and assess hospital-related outcomes. For the study, they abstracted data from the Pediatric Health Information System (PHIS) database, which includes information on admissions to 49 tertiary care children’s hospitals across the US. Participants for the current study were children 2 months through 17 years old hospitalized at a PHIS hospital during the influenza seasons from 2015 through 2020 with an ICD-10 diagnostic code for influenza. Information abstracted from the PHIS database on these patients included demographic data, geographic region, hospital length of stay (LOS), ICU admission, other ICD-10 diagnoses, presence of chronic neurologic conditions (defined using the pediatric complex chronic conditions classification system version 2), and hospital charges. The primary study outcome was an ICD-10 code for a neurologic complication, including febrile seizure, non-febrile seizure, encephalopathy, encephalitis, aseptic meningitis, brain abscess and bacterial meningitis, Reye syndrome, and cerebral infarction. Multivariate regression analyses to identify risk factors for a neurologic complication, with controlling for confounders, were conducted. Predominant influenza type was included in the regression model and estimated from CDC influenza surveillance data in each patient’s census division during the week that they were hospitalized. Bivariate analyses were used to compare hospital-related outcomes including LOS, ICU admission, costs (estimated from charge data), and in-hospital death rates among patients with and without neurologic complications. Data were analyzed on 29,676 children hospitalized with influenza. The median age of the included patients was 4 years, and 56% were male. A total of 2,246 (7.6%) had a neurologic complication. The most common neurologic complications were febrile seizure (N = 1,447, 5.0% of influenza admissions), encephalopathy (514, 1.7%), and non-febrile seizure (364, 1.2%). Risk factors identified in the multivariate analyses included male sex (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0, 1.2), Asian race (OR, 1.7; 95% CI, 1.4, 2.1), other race (includes Pacific Islander, American Indian, multiracial, and other; OR, 1.2; 95% CI, 1.03, 1.4), and presence of a chronic neurologic condition (OR, 3.7; 95% CI, 3.1, 4.2). There was no statistical association between predominant influenza type and neurologic complication. Patients with neurologic complications had longer ICU LOS than those without (mean values 2.7 and 2.2 days, respectively; P <0.05), a higher rate of ICU admissions (24.5% vs 15.3%; P <0.001), a higher rate of in-hospital death (0.7% vs 0.2%; P <0.001), and higher costs (mean costs $6,013 vs $5,282; P <0.001). The authors conclude that neurologic complications were common among children hospitalized with influenza, particularly in those with chronic neurologic conditions. Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. For... You do not currently have access to this content.