Severity of complications in pediatric influenza-like illness identified

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.

Click to read the study, published today in Pediatrics

Relevant Reading: Epidemiology, Complications, and Cost of Hospitalization in Children with Laboratoy-Confirmed Influenza Infection

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.

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Image: PD

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