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Pediatric neurological complications of 2009 pandemic influenza A (H1N1)
Sita Kedia1, Britt Stroud, Julie Parsons
1Department of Child Neurology, The Children's Hospital, University of Colorado School of Medicine, Aurora, USA.
Insights
Pandemic influenza A H1N1 virus (pH1N1) caused severe neurological complications in children, especially those with prior neurological conditions. Aggressive treatment and prevention are crucial for these vulnerable children.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Virology
Background:
- The 2009 pandemic influenza A H1N1 virus (pH1N1) posed a significant global health threat.
- Neurological complications in pediatric influenza cases require thorough investigation.
Observation:
- A retrospective case series analyzed children hospitalized with pH1N1 between May and November 2009.
- Fifty-nine suspected cases of neurological complications were identified, with 23 confirmed.
- Seventeen of the confirmed cases (74%) had pre-existing neurological conditions.
Findings:
- The most frequent neurological manifestation was seizures (62%), followed by encephalopathy (26%).
- Lumbar punctures revealed elevated protein in 3/6 patients; EEG showed diffuse slowing in 7/9; MRI was abnormal in 5/6.
- Thirteen percent of patients died, and 22% experienced short-term disability.
Implications:
- pH1N1 infection can lead to a diverse range of severe neurological outcomes in children.
- Children with pre-existing neurological conditions are at higher risk for severe disease and adverse outcomes.
- Targeted influenza prevention and prompt, aggressive treatment are essential for high-risk pediatric populations.
Objective:
To analyze the spectrum of neurological manifestations in children hospitalized with pandemic influenza A H1N1 virus of 2009 (pH1N1).
Design:
Retrospective case series of children hospitalized from May 1, 2009, through November 30, 2009.
Setting:
Tertiary-care children's hospital in Colorado.
Patients:
All hospitalized patients with pH1N1 with neurological consult or diagnosis, lumbar puncture, electroencephalogram, or neuroimaging were selected as suspected cases. These were systematically reviewed and selected for final analysis if confirmed by pre-established definitions as a neurological complication.
Results:
Of 307 children with pH1N1, 59 were selected as having suspected cases of neurological complications. Twenty-three children were confirmed to have a neurological complication. Of these 23, 15 (65%) required intensive care monitoring. The median length of stay was 4 days. Seventeen (74%) had a preexisting neurological diagnosis. The most common manifestation was seizure with underlying neurological disease (in 62% of cases) followed by encephalopathy with or without neuroimaging changes (in 26% of cases). Results from a lumbar puncture showed elevated protein levels in 3 of 6 patients but no significant pleocytosis. Seven of the 9 electroencephalograms showed diffuse slowing, and findings from magnetic resonance imaging were abnormal in 5 of 6 children. Deaths occurred in 13% of patients, and short-term disability in 22%.
Conclusions:
Children infected with pH1N1 presented with a wide spectrum of neurological manifestations, which occurred primarily in individuals with preexisting neurological conditions. These individuals had a severe disease course, evidenced by need for intensive care services and relatively high rates of mortality or neurological disability. Children with underlying neurological conditions should be particularly targeted for influenza prevention and aggressive supportive treatment at the onset of influenzalike symptoms.
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