title: Risk factors associated with severe influenza virus infections in hospitalized children during the 2013 to 2014 season.
abstract: BACKGROUND
  An outbreak of influenza virus infection occurred in Taiwan from October 2013 to May 2014. We conducted a clinical study to identify risk factors associated with severe influenza virus infections in children.
  
  
  METHODS
  During the outbreak period, data from 110 hospitalized children with influenza virus infection were collected. We analyzed the data, the need for intensive care, and patient outcome to identify clinical features and risk factors of severe infections, defined as the need of intensive care.
  
  
  RESULTS
  Of the 110 inpatients, there were 57 male and 53 female patients; the median age was 2.6 (interquartile range, 1.0-6.3) years. Nineteen patients required intensive care and two patients died. Children who were underweight (p = 0.01) or those with neuromuscular disease (p = 0.007) and digestive tract disease (p = 0.03) were prone to severe infection. Occurrence of seizure (p = 0.004), conscious disturbance (p = 0.02), or low oxygen saturation at admission (p = 0.04) predicted the need for intensive care. Higher initial absolute neutrophil count (p = 0.02) and patch or pleural effusion on chest X-ray examination (p = 0.02) were associated with severe infection. In the multivariable analysis, digestive tract disease [p = 0.03; adjusted odds ratio (OR), 12.37; 95% confidence interval (CI), 1.28-119.43], seizure (p = 0.001; adjusted OR, 49.54; 95% CI, 4.61-532.76) and conscious disturbance (p = 0.006; adjusted OR, 131.61; 95% CI, 4.18-4141.64) were most significantly associated with severe influenza virus infection.
  
  
  CONCLUSIONS
  Close monitoring of the important risk factors including underlying digestive tract diseases, seizure attack and conscious disturbance were recommended during the influenza season.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan.
authors.forename: Hsuan-Yin
authors.initials: HY
authors.lastname: Ma
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan.
authors.forename: Jhong-Lin
authors.initials: JL
authors.lastname: Wu
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan.
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Lu
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan.
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Chen
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan.
authors.forename: Ping-Ing
authors.initials: PI
authors.lastname: Lee
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan. Electronic address: ly7077@tpts6.seed.net.tw.
authors.forename: Luan-Yin
authors.initials: LY
authors.lastname: Chang
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan.
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Huang
mesh_terms: D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D004196:Disease Outbreaks; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D053122:Influenza A Virus, H3N2 Subtype / Q000302:isolation & purification*; D009981:Influenza B virus / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D008297:Male; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
keywords: Children; Influenza; Risk factors