Influenza: Complications in 1 in 3 Previously Healthy Kids

Diedtra Henderson

August 04, 2014

As many as 1 in 3 children seeking treatment in the emergency department for influenza-like illnesses (ILI) at the peak of influenza season are at high risk of suffering severe complications, such as pneumonia, according to a prospective cohort study. The risks are even higher for children with neurologic or neuromuscular conditions. The data support more frequent use of antiviral therapy for both at-risk and previously healthy children, the authors say.

Rakesh D. Mistry, MD, from the Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, and coauthors published their findings online August 4 in Pediatrics.

When children come to the emergency department at the height of influenza season, diagnosis and treatment can be complicated, they write. Many of the children have the sore throat, fever, and cough that are typical symptoms of the ailment, but confirmatory testing of viral infections takes time. The researchers sought to determine the rates of severe complications among children who arrived at the emergency department with moderate to severe ILI.

From 2008 to 2010, 125,940 children aged younger than 19 years were treated during the peak respiratory viral season in the emergency department of an urban tertiary hospital. Of those, 241 participants were enrolled in the study. Their median age was 27.4 months, 147 of them were boys, and 117 of them were black. (The authors note that this was a planned secondary analysis of a prospective cohort study but do not elaborate on the original study aims.)

During the study period, 85 (35.3%; 95% confidence interval [CI], 29.3% - 41.3%) of the children suffered severe complications, according to the authors, with 63 experiencing pneumonia, 12 suffering respiratory failure, and 14 suffering seizures. One patient, a previously healthy 4-week-old infant, died.

"In this investigation of children presenting with moderate to severe ILI evaluated in the [emergency department], we determined that 1 in every 3 children will subsequently develop a severe complication, most frequently pneumonia. Notably, children with known neurologic or neuromuscular conditions were at substantially higher risk of complications; however, children with other high-risk conditions did not appear to be at increased risk," Dr. Mistry and coauthors write.

The authors say their findings support the use of antiviral therapy, which decreases the risk for severe complications in children known to have influenza and whose benefits to children outweigh the risks.

"[U]p to 40% of children who developed severe complications did not have any underlying comorbidity, indicating that physicians need a broad concern for children presenting with ILI, and should continue to assess individual patient risk for development to severe complications regardless of known viral testing result," the authors conclude.

Financial support for the study was provided by the Commonwealth of Pennsylvania Department of Health. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online August 4, 2014.


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