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Influenza in Children With Special Risk Medical Conditions: A Systematic Review and Meta-analysis

Jane Tuckerman1,2, Siobhan Misan3, Nigel W Crawford4,5

  • 1From the Discipline of Paediatrics, Adelaide Medical School.

The Pediatric Infectious Disease Journal
|July 6, 2019
PubMed

Insights

Children with special risk medical conditions (SRMC) face higher risks of intensive care unit (ICU) admission and bacterial pneumonia when hospitalized with influenza. Evidence for increased death or mechanical ventilation needs remains inconsistent, warranting further research.

Area of Science:

  • Pediatric Infectious Diseases
  • Epidemiology
  • Public Health

Background:

  • Children with special risk medical conditions (SRMC) are disproportionately hospitalized with influenza.
  • Influenza infection can lead to severe outcomes in vulnerable pediatric populations.

Purpose of the Study:

  • To systematically review and determine if children with SRMC experience greater complications or severity following influenza infection compared to healthy children.
  • To synthesize evidence on influenza-related morbidity and mortality in children with SRMC.

Main Methods:

  • A systematic review of studies published between 1990 and March 2018, searching MEDLINE and EMBASE databases.
  • Inclusion of studies involving children (≤18 years) with SRMC hospitalized for influenza, examining outcomes like pneumonia, ICU admission, mechanical ventilation, neurological outcomes, death, and length of stay.
  • Contact with investigators of unpublished studies to include relevant data.

Main Results:

  • Twenty-two studies met inclusion criteria, revealing higher odds of ICU admission (OR 1.66) in children with SRMC.
  • Increased likelihood of developing bacterial pneumonia (OR 1.7) and prolonged hospital stays (ARR 1.75) were observed in this group.
  • Evidence for increased odds of mechanical ventilation (OR 1.53) and death (OR 1.34) was inconsistent, with low GRADE evidence for all outcomes.

Conclusions:

  • Children with SRMC have increased risks for ICU admission and bacterial pneumonia during influenza hospitalization.
  • Evidence for increased mortality or need for mechanical ventilation is inconsistent, highlighting the need for further investigation.
  • Further research using large datasets is recommended to fully understand the impact of influenza complications and morbidity in SRMC children.
Abstract

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