Association of Early Oseltamivir With Improved Outcomes in Hospitalized Children With Influenza, 2007-2020
Patrick S Walsh1, David Schnadower1,2, Yin Zhang3
1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Early oseltamivir treatment in hospitalized children significantly reduces hospital stay and lowers the risk of readmission, intensive care unit transfer, and death. These findings support current recommendations for influenza treatment in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Health Outcomes Research
Background:
- Oseltamivir is recommended for hospitalized children with influenza, but evidence for its inpatient effectiveness is limited.
- Understanding the impact of early oseltamivir administration is crucial for optimizing pediatric influenza care.
Purpose of the Study:
- To evaluate the association between early oseltamivir use and clinical outcomes in children hospitalized with influenza.
Main Methods:
- Retrospective analysis of 55,799 pediatric influenza hospitalizations across 36 centers (2007-2020).
- Early oseltamivir defined as treatment on hospital day 0 or 1.
- Inverse probability treatment weighting (IPTW) and mixed-effects models used to compare outcomes, including length of stay (LOS), 7-day readmission, intensive care unit (ICU) transfer, and composite death/ECMO outcome.
Main Results:
- Early oseltamivir treatment (59.5% of cohort) was associated with a significantly shorter hospital LOS (median 3 vs. 4 days).
- Reduced odds of 7-day readmission (aOR 0.72), late ICU transfer (aOR 0.41), and death or ECMO use (aOR 0.63) were observed with early treatment.
- Benefits were consistent across high-risk pediatric subgroups.
Conclusions:
- Early oseltamivir use in children hospitalized with influenza is linked to improved clinical outcomes.
- Findings support current guidelines recommending oseltamivir for pediatric influenza hospitalizations.
Importance:
Oseltamivir is recommended for all children hospitalized with influenza, despite limited evidence supporting its use in the inpatient setting.
Objective:
To determine whether early oseltamivir use is associated with improved outcomes in children hospitalized with influenza.
Design, Setting, And Participants:
This multicenter retrospective study included 55 799 children younger than 18 years who were hospitalized with influenza from October 1, 2007, to March 31, 2020, in 36 tertiary care pediatric hospitals who participate in the Pediatric Health Information System database. Data were analyzed from January 2021 to March 2022.
Exposures:
Early oseltamivir treatment, defined as use of oseltamivir on hospital day 0 or 1.
Main Outcomes And Measures:
The primary outcome was hospital length of stay (LOS) in calendar days. Secondary outcomes included 7-day hospital readmission, late (hospital day 2 or later) intensive care unit (ICU) transfer, and a composite outcome of in-hospital death or use of extracorporeal membrane oxygenation (ECMO). Inverse probability treatment weighting (IPTW) based on propensity scoring was used to address confounding by indication. Mixed-effects models were used to compare outcomes between children who did and did not receive early oseltamivir treatment. Outcomes were also compared within high-risk subgroups based on age, presence of a complex chronic condition, early critical illness, and history of asthma.
Results:
The analysis included 55 799 encounters from 36 hospitals. The median (IQR) age of the cohort was 3.61 years (1.03-8.27); 56% were male, and 44% were female. A total of 33 207 patients (59.5%) received early oseltamivir. In propensity score-weighted models, we found that children treated with early oseltamivir had shorter LOS (median 3 vs 4 days; IPTW model ratio, 0.52; 95% CI, 0.52-0.53) and lower odds of all-cause 7-day hospital readmission (3.5% vs 4.8%; adjusted odds ratio [aOR], 0.72; 95% CI, 0.66-0.77), late ICU transfer (2.4% vs 5.5%; aOR, 0.41; 95% CI, 0.37-0.46), and the composite outcome of death or ECMO use (0.9% vs 1.4%; aOR, 0.63; 95% CI, 0.54-0.73).
Conclusions And Relevance:
Early use of oseltamivir in hospitalized children was associated with shorter hospital stay and lower odds of 7-day readmission, ICU transfer, ECMO use, and death. These findings support the current recommendations for oseltamivir use in children hospitalized with influenza.
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