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Abstract
Objective: We sought to determine the range and extent of neurologic complications due to pandemic influenza A (H1N1) 2009 infection (pH1N1′09) in children hospitalized with influenza.
Methods: Active hospital-based surveillance in 6 Australian tertiary pediatric referral centers between June 1 and September 30, 2009, for children aged <15 years with laboratory-confirmed pH1N1′09.
Results: A total of 506 children with pH1N1′09 were hospitalized, of whom 49 (9.7%) had neurologic complications; median age 4.8 years (range 0.5–12.6 years) compared with 3.7 years (0.01–14.9 years) in those without complications. Approximately one-half (55.1%) of the children with neurologic complications had preexisting medical conditions, and 42.8% had preexisting neurologic conditions. On presentation, only 36.7% had the triad of cough, fever, and coryza/runny nose, whereas 38.7% had only 1 or no respiratory symptoms. Seizure was the most common neurologic complication (7.5%). Others included encephalitis/encephalopathy (1.4%), confusion/disorientation (1.0%), loss of consciousness (1.0%), and paralysis/Guillain-Barré syndrome (0.4%). A total of 30.6% needed intensive care unit (ICU) admission, 24.5% required mechanical ventilation, and 2 (4.1%) died. The mean length of stay in hospital was 6.5 days (median 3 days) and mean ICU stay was 4.4 days (median 1.5 days).
Conclusions: Neurologic complications are relatively common among children admitted with influenza, and can be life-threatening. The lack of specific treatment for influenza-related neurologic complications underlines the importance of early diagnosis, use of antivirals, and universal influenza vaccination in children. Clinicians should consider influenza in children with neurologic symptoms even with a paucity of respiratory symptoms.
GLOSSARY
- APSU=
- Australian Pediatric Surveillance Unit;
- CHW=
- Children's Hospital at Westmead;
- CI=
- confidence interval;
- EL=
- encephalitis lethargica;
- GBS=
- Guillain-Barré syndrome;
- HAPS=
- Hunter Area Pathology Service;
- ICU=
- intensive care unit;
- ILAE=
- International League Against Epilepsy;
- ILI=
- influenza-like illness;
- JHCH=
- John Hunter Children's Hospital;
- LOS=
- length of stay;
- NCIRS=
- National Centre for Immunization Research and Surveillance;
- PAEDS=
- Pediatric Active Enhanced Disease Surveillance;
- PMH=
- Princes Margaret Hospital Perth;
- RCH=
- Royal Children's Hospital Melbourne;
- SCH=
- Sydney Children's Hospital;
- SEALS=
- South Eastern Area Laboratory Service;
- VIDRL=
- Victorian Infectious Diseases Reference Laboratory;
- WCH=
- Women's and Children's Hospital Adelaide.
Footnotes
Supplemental data at www.neurology.org
- Received September 24, 2011.
- Accepted April 19, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
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