What are the clinical characteristics of the neurological complications of H1N1 influenza (swine flu) in children?

Updated: Apr 09, 2019
  • Author: Michael Stuart Bronze, MD; Chief Editor: Russell W Steele, MD  more...
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In children hospitalized for influenza, neurologic complications are common and sometimes life-threatening. In an effort to assess the extent and range of such complications in this population, Australian investigators in 6 tertiary pediatric referral centers carried out active hospital-based surveillance of 506 children younger than 15 years who had laboratory-confirmed pandemic influenza A (H1N1) 2009 infection (pH1N1'09). [23] Of the 506, 49 (9.7%) had neurologic complications.

Further study findings were as follows:

  • Patients with neurologic complications tended to be slightly older than those without (median age, 4.8 years versus 3.7 years)

  • Of patients with neurologic complications, 55.1% had preexisting medical conditions and 42.8% had preexisting neurologic conditions

  • On presentation, only 36.7% had cough, fever, and coryza or runny nose; 38.7% had only 1 respiratory symptom or none at all

  • Neurologic complications, in descending order of frequency, included seizure (7.5%), encephalitis or encephalopathy (1.4%), confusion or disorientation (1.0%), loss of consciousness (1.0%), and paralysis or Guillain-Barré syndrome (0.4%)

  • Intensive care unit (ICU) admission was required in 30.6% of the patients, mechanical ventilation in 24.5%

  • Mean hospital stay was 6.5 days, mean ICU stay 4.4 days

  • Two (4.1%) of the 49 patients died

Specific treatment for influenza-related neurologic complications is generally unavailable. Consequently, early diagnosis of influenza, appropriate use of antiviral therapy, and universal influenza vaccination in children are vital. Influenza should be considered as a diagnosis in children with neurologic symptoms, even when few or even no respiratory symptoms are noted.

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