1. Over 1/3 of children presenting to a tertiary emergency department (ED) with influenza-like illness went on to develop severe complications, including respiratory failure, encephalopathy, seizures, pneumonia, bacteremia, and death.
2. Children with underlying neurological or neuromuscular disease were 4 times more likely to develop complications compared to other children.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Influenza-like illness (ILI) affects thousands of children yearly, predominantly during the winter months. While many of these children are managed in the outpatient clinic setting, some present to the ED with moderate to severe symptoms. This study examined complication rates from such children with ILI in the ED. It found that those children with underlying neurological or neuromuscular disease were most at risk for ILI complications. Though the rate of complication development did not differ by the specific virus causing the illness, children with influenza subtype H1N1 were more likely to have severe complications compared to other influenza subtypes. Given that the study participants all had symptoms severe enough to warrant presentation to the ED, these findings may be limited by spectrum bias. Nevertheless, since over 1/3 of included children went on to develop ILI complications, this study points to the importance of antiviral treatment for all children with ILI presenting to the ED.
In-Depth [prospective cohort]: This study was a secondary analysis of a prospective cohort of 241 children ages 0 to 19 years presenting to a tertiary ED with symptoms of ILI. All participants had symptoms significant enough to warrant venipuncture and nasopharyngeal aspirate as diagnostic measures. Measured ILI complications were respiratory failure, encephalopathy, seizures, pneumonia, bacteremia, and death. One or more of these complications occurred in 35.3% of studied children, with pneumonia (26.1%) being most common. In terms of microbiology, the rate of complications was similar between influenza (A, B, H1N1) and non-influenza (rhinovirus, RSV, human metapneumovirus, adenovirus, parainfluenza virus) groups. However, children with the H1N1 influenza subtype were 1.45 times more likely (P = 0.048) to have severe complications compared to other influenza subtypes A and B. Children with underlying neurological or neuromuscular disease were 4 times more likely to develop ILI complications compared to otherwise healthy children (95% CI: 1.9-8.2). Beyond this, no other patient or demographic criteria were noted to be associated with complication development.
More from this author: High prevalence of pediatric dosing errors suggests unit standardization, Sexting linked to sexual activity in middle school students, Possible benefit in omega-3 supplementation for extremely preterm infants, PTSD symptoms in Boston-area youth after marathon bombing, AAP issues update on iodine deficiency and associated pollutants
©2012-2014 2minutemedicine.com. All rights reserved. No works may be reproduced without expressed written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT.