title: Neurological sequelae of 2009 influenza A (H1N1) in children: a case series observed during a pandemic.
abstract: OBJECTIVE
  To outline a series of cases demonstrating neurologic complications in children with Influenza infection. The ongoing 2009 influenza A (H1N1) presents significant challenges to the field of pediatric critical care and requires increased awareness of new presentations and sequelae of infection. Since World Health Organization declared a H1N1 pandemic, much attention has been focused on its respiratory manifestations of the illness, but limited information regarding neurologic complications has been reported.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Pediatric intensive care unit of a tertiary care medical facility.
  
  
  METHODS
  Four children admitted to the pediatric intensive care unit between March and November 2009 at the Children's Hospital of Pittsburgh with altered mental status and influenza infection.
  
  
  METHODS
  None.
  
  
  RESULTS
  The clinical course was extracted by chart review and is summarized. All children demonstrated a coryzal prodrome, fever, and altered level of consciousness at admission, and one child presented with clinical seizures. Diagnostic studies performed to establish a diagnosis are summarized. All children had abnormal electroencephalograms early in their intensive care unit course and 50% had abnormal imaging studies. All children survived but 50% had neurologic deficits at hospital discharge.
  
  
  CONCLUSIONS
  We conclude that 2009 influenza A (H1N1) can cause significant acute and residual neurologic sequelae. Clinicians should consider Influenza within a comprehensive differential diagnosis in children with unexplained mental status changes during periods of pandemic influenza.
authors.affiliation: Department of Critical Care Medicine and the Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Sirine A
authors.initials: SA
authors.lastname: Baltagi
authors.forename: Michael
authors.initials: M
authors.lastname: Shoykhet
authors.forename: Kathryn
authors.initials: K
authors.lastname: Felmet
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kochanek
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000472:pathogenicity*; D007251:Influenza, Human / Q000150:complications*; D015278:Intensive Care Units, Pediatric; D008297:Male; D009422:Nervous System Diseases / Q000503:physiopathology* / Q000821:virology*; D010414:Pennsylvania