RT Journal Article
SR Electronic
T1 Neurologic complications of influenza A(H1N1)pdm09
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1474
OP 1481
DO 10.1212/WNL.0b013e31826d5ea7
VO 79
IS 14
A1 Khandaker, Gulam
A1 Zurynski, Yvonne
A1 Buttery, Jim
A1 Marshall, Helen
A1 Richmond, Peter C.
A1 Dale, Russell C.
A1 Royle, Jenny
A1 Gold, Michael
A1 Snelling, Tom
A1 Whitehead, Bruce
A1 Jones, Cheryl
A1 Heron, Leon
A1 McCaskill, Mary
A1 Macartney, Kristine
A1 Elliott, Elizabeth J.
A1 Booy, Robert
YR 2012
UL http://n.neurology.org/content/79/14/1474.abstract
AB 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. 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.