Related Experiment Video
Updated: Jun 5, 2025
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Pediatric Patients With Acute Flaccid Myelitis: Long-term Respiratory and Neurologic Outcomes
Dimple Patel1,2,3, Emily A Kragel4, Shih-Dun Liu4
1From the Pediatric Hospital Medicine Fellowship, Kaiser Permanente Oakland Medical Center, Oakland, CA.
Insights
Pediatric acute flaccid myelitis (AFM) patients with respiratory failure at presentation face worse outcomes. These include needing long-term respiratory support and experiencing prolonged neurologic deficits.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Acute flaccid myelitis (AFM) is a neurologic condition often linked to infections.
- AFM can lead to respiratory failure and variable recovery.
- Understanding long-term outcomes based on initial respiratory status is crucial.
Purpose of the Study:
- To assess long-term respiratory and neurologic outcomes in pediatric AFM patients.
- To provide data on outcomes stratified by respiratory status at presentation.
- To contribute to the limited literature on pediatric AFM.
Main Methods:
- Retrospective cohort study utilizing a large healthcare database.
- Identified pediatric patients (1-18 years) diagnosed with AFM (2011-2019).
- Compared outcomes between patients with and without respiratory failure during hospitalization.
Main Results:
- Overall AFM incidence was 0.6 per 100,000 person-years.
- 21.6% of AFM patients experienced respiratory failure.
- Respiratory failure was associated with higher Modified Rankin Scores and increased healthcare utilization.
Conclusions:
- Respiratory failure at AFM presentation predicts worse outcomes.
- Patients with respiratory failure require more respiratory support and have prolonged deficits.
- Findings highlight the impact of initial respiratory status on pediatric AFM prognosis.
Background:
Acute flaccid myelitis (AFM), an infection-mediated neurologic condition, may be accompanied by respiratory failure and subsequent variable recovery. This study assessed and provided prescriptive data on long-term respiratory and neurologic outcomes according to respiratory status at the time of presentation.
Methods:
This was a retrospective cohort study using a large, single-payer healthcare database to identify children 1-18 years old, diagnosed with AFM between January 1, 2011 and December 31, 2019. Descriptive statistics described the overall cohort and the cohort by respiratory failure status. Bivariate analyses evaluated incidence rate ratios of outcome data, comparing those with respiratory failure to those without.
Results:
A total of 37 patients met the study criteria for AFM; 28 were from a previously established cohort. Median follow-up time was 4.7 years [interquartile range (IQR): 2.39-6.06]. Overall incidence rate of AFM over the study period was 0.6 per 100,000 person-years. Eight patients (21.6%) had respiratory failure during the index hospitalization. Among children with respiratory failure, 6 patients (75%) required follow-up respiratory support. Those with respiratory failure had higher Modified Rankin Scores [mean difference 1.29, 95% confidence interval (CI): 0.34-2.23] and a higher rate of respiratory-related emergency and in-hospital visits (incidence rate ratios 1.94; 95% CI: 1.27-2.96) compared to those without respiratory failure.
Conclusions:
Having respiratory failure at presentation was observed to have worse outcomes, including the need for long-term respiratory support, higher healthcare utilization, and prolonged neurologic deficits. This study contributes to the scant literature on pediatric patients with AFM.
