Critical Care Medicine| January 01 2006 Risk Factors for Respiratory Failure in Hospitalized Children with Influenza AAP Grand Rounds (2006) 15 (1): 6. https://doi.org/10.1542/gr.15-1-6 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Risk Factors for Respiratory Failure in Hospitalized Children with Influenza. AAP Grand Rounds January 2006; 15 (1): 6. https://doi.org/10.1542/gr.15-1-6 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: child, hospitalized, influenza, respiratory insufficiency Source: Keren R, Zaoutis TE, Bridges CB, et al. Neurological and neuromuscular disease as a risk factor for respiratory failure in children hospitalized with influenza infection. JAMA. 2005;294:2188–2194. The authors from the Children’s Hospital of Philadelphia performed a retrospective cohort study of children 21 years and younger admitted to the hospital with community- acquired laboratory-confirmed influenza infection from June 2000 thorough May 2004. They evaluated the 9 chronic conditions identified by the Advisory Committee on Immunization Practices (ACIP) for which annual influenza vaccination is recommended1 to determine if these conditions were associated with need for hospital care after influenza infection. These conditions include asthma, chronic pulmonary disease, cardiac disease, immunosuppression, hemoglobinopathies, chronic kidney dysfunction, metabolic and endocrine conditions, long-term salicylate therapy, and pregnancy. The authors also evaluated children with chronic neurological and neuromuscular disease (NNMD), gastroesophageal reflux, and a history of prematurity. The authors defined respiratory failure as use of mechanical ventilation, and evaluated factors associated with respiratory failure. There were 745 patients identified, of whom 32 (4%) received mechanical ventilation. Five children (0.6%) died and all developed respiratory failure prior to death. The most common ACIP-identified condition associated with hospital admission was asthma (24%), followed by immunosuppressive therapy (8%), heart disease (7%), and hemoglobinopathy (6%). Three hundred twenty-two (43%) patients had at least 1 ACIP-identified condition and 71 children (10%) had 2 or more. Two hundred fifty (34%) children were between 6 months and 2 years of age, a group for whom vaccination is recommended. Two hundred seventy-nine children (37%) were both 2 years of age or older and without an ACIP-identified condition. Eighty-nine patients (12%) had a NNMD and 102 (14%) had gastroesophageal reflux, while history of prematurity was less common (n=23, 3%). The authors evaluated conditions associated with respiratory failure and found that NNMD (OR 6.0; 95% CI, 2.7–13.5), hemoglobinopathy (OR 4.8; 95% CI, 1.5–15.1), immunosuppressive therapy (OR 4.0; 95% CI, 1.6–10.2), and chronic kidney disease (OR 3.9; 95% CI, 0.7–20.7) were risk factors for mechanical ventilation. Of the 5 children who died, only 1 had no preexisting medical condition. Dr. Bratton has disclosed no financial relationships relevant to this commentary. Concerns regarding influenza infections and a possible pandemic are prominent in the national and international press.2,3 Young children and the elderly are known to have high rates of hospitalization with influenza infections, and children are typically among the first recognized cases and can spread infections to adults. The above paper suggests that an additional high-risk group of patients for whom vaccination should be recommended to prevent severe disease is children with neurological conditions. The relatively small sample size prevented analysis of risk factors for carditis, encephalitis, and death. Pediatricians – both primary care and specialty providers – must focus on immunization for both healthy children 6 to 23 months of age and children with high-risk medical conditions. A recent publication regarding missed influenza vaccination opportunities among children with asthma reported that over 80% of asthma-related visits... You do not currently have access to this content.