Influenza-associated Neurologic Complications in Children: Insights From a Single-center Study in Oman

Influenza infection can lead to substantial morbidity and mortality, especially when accompanied by neurological complications. This study aims to evaluate the frequency of influenza-associated neurologic complications (IANC) in children with confirmed influenza A or B virus infections, as well as to delineate their clinical characteristics, neuroimaging findings, laboratory results, treatment protocols, outcomes and related risk factors in children.

This retrospective cohort study screened all individuals under 18 years of age with influenza virus confirmed by polymerase chain reaction for IANC from January 2012 to January 2023. Only patients eligible for the diagnosis of IANC were included in the analysis. Clinical and neuroimaging data were extracted from medical records. The statistical analysis was conducted utilizing Statistical Package for the Social Sciences version 29.

A total of 680 patients with positive influenza A/B viruses were included, of whom 38 (5.6%) had IANC. The IANC rate was slightly higher among females (6.2%) compared with males (5.1%) ( P = 0.616), with a median age of 4 years. Most patients (33; 86.8%) showed central nervous system complications, 4 patients (10.5%) had peripheral nervous system manifestations, and only 1 patient (1; 2%) had both systems affected. Febrile seizures were the most frequent complications in IANC cases (15/38, 39.5%), followed by influenza-related encephalopathy (10/38, 26.3%) and acute necrotizing encephalopathy of childhood (4/38, 10.5%). The mortality rate was 13.2% (5 patients). Immune comorbidities were associated with a high mortality rate among all the studied risk factors ( P = 0.005).

Although uncommon, IANC poses a significant hazard to life and exhibits a high mortality rate. IANC is more prevalent in children under 5 years in our population, which indicates the importance of influenza immunization in this population.