Neurological and neuromuscular disease as a risk factor for respiratory failure in children hospitalized with influenza infection.
BACKGROUND
The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for children with certain chronic medical conditions to prevent serious complications of influenza infection. Little is known about the relative contribution of each of these chronic medical conditions to the development of serious influenza-associated complications.


OBJECTIVE
To identify chronic medical conditions that are associated with respiratory failure in children hospitalized with community-acquired laboratory-confirmed influenza.


METHODS
A retrospective cohort study of patients aged 21 years or younger hospitalized at The Children's Hospital of Philadelphia with community-acquired laboratory-confirmed influenza during 4 consecutive influenza seasons (June 2000 through May 2004). We examined 9 ACIP-designated high-risk chronic medical conditions and 3 additional chronic medical conditions (neurological and neuromuscular disease [NNMD], gastroesophageal reflux disease [GERD], and history of prematurity) that in recent studies have been associated with influenza hospitalization and severe influenza-related complications.


METHODS
Rate and odds ratio (OR) of respiratory failure, defined as need for mechanical ventilation.


RESULTS
Of 745 children hospitalized with community-acquired laboratory-confirmed influenza, 322 (43%) had 1 or more ACIP-designated high-risk chronic medical conditions. Neurological and neuromuscular disease, GERD, and history of prematurity were present in 12%, 14%, and 3%, of children, respectively. Thirty-two children (4.3%) developed respiratory failure. In multivariate logistic regression analyses, conditions associated with respiratory failure included NNMD (OR, 6.0; 95% confidence interval [CI], 2.7-13.5), chronic pulmonary disease other than asthma (OR, 4.8; 95% CI, 1.5-15.1), and cardiac disease (OR, 4.0; 95% CI, 1.6-10.2). The predicted probabilities of respiratory failure derived from the multivariate model were 12% (95% CI, 7%-20%), 9% (95% CI, 3%-23%), and 8% (95% CI, 4%-18%) for children with NNMD, chronic pulmonary disease, and cardiac disease, respectively.


CONCLUSIONS
These results support the ACIP's recent decision to add NNMD to the list of conditions for which annual influenza vaccine is recommended in children. Neurologists and primary care pediatricians should be alerted to the increased risk of respiratory failure and the importance of influenza vaccination in children with NNMD.
Keren
Ron
R
Division of General Pediatrics, Pediatric Generalist Research Group, Department of Medicine, The Children's Hospital of Philadelphia, PA 19104, USA. keren@email.chop.edu
Zaoutis
Theoklis E
TE
Bridges
Carolyn B
CB
Herrera
Guillermo
G
Watson
Barbara M
BM
Wheeler
Anna B
AB
Licht
Daniel J
DJ
Luan
Xian Qun
XQ
Coffin
Susan E
SE
D000293:Adolescent; D000328:Adult; D002493:Central Nervous System Diseases / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications; D005260:Female; D005764:Gastroesophageal Reflux; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007251:Influenza, Human / Q000150:complications*; D016015:Logistic Models; D008297:Male; D009468:Neuromuscular Diseases / Q000150:complications*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors