Volume 157, December 2022, 105298AbstractBackground

Apart from age and underlying disease, predictors of adverse outcome in children hospitalized with influenza are poorly understood.

Objectives

Our goal is to determine clinical and laboratory predictors that help identify children at increased risk for an unfavorable course and identify differences in clinical presentation between serotypes.

Study design

A retrospective, observational cohort study conducted at the Rambam Healthcare Campus in Haifa. We analyzed data from electronic records of children < 18 years with influenza A or B infection hospitalized between 2009 and 2020. Multivariate regression analyses were used to identify predictors of unfavorable outcome, defined as mortality, ICU admission, intubation, prolonged length of stay, or bacterial coinfection.

Results

A total of 1077 children were included, of whom 54% were male. The median age was 2.5 years. Influenza A was detected in 797 (74%) and influenza B in 286 (26%) of the cases. Children with influenza A were younger (OR 2.51, 95%CI 1.90–3.33), more likely to have oxygen desaturation <90% (OR 2.44, 95%CI 1.23–4.83) and an elevated CRP>5 mg/dL on admission (OR 2.67, 95% CI 1.63–4.37). In multivariate analyses, oxygen desaturation <90% and CRP > 5 mg/dL at admission had an 11.1 and 4-fold increased risk of unfavorable outcome, respectively, in addition to a 3.1 and 1.6-fold increased risk in the presence of underlying condition or influenza A serotype infection, respectively.

Conclusions

Data available on admission can help identify children hospitalized with influenza who are at increased risk for complications and unfavorable outcome, encouraging aggressive treatment and care.

Section snippetsBackground

Influenza is a major public health problem and is associated with a significant burden of disease in healthy children, high rates of hospitalization and substantial morbidity and mortality. Complications of influenza occur in approximately one-quarter of diagnosed pediatric cases and include secondary bacterial infections in most cases and, less commonly, neurologic complications such as seizures and encephalitis [1,2]. The ICDC (Israeli Center of Disease Control) reported a total of 148

Objectives

The objectives of this study is to determine clinical and laboratory predictors, in children with influenza infection, that will help identify children at increased risk for an unfavorable outcome and identify differences in clinical presentation among serotypes. Identification of such predictors, particularly those available at hospital admission, may have a positive impact on management and outcome.

Study design

A retrospective, observational cohort study conducted at Ruth Rappaport Children's Hospital, Rambam Healthcare Campus in Haifa, a tertiary referral hospital with one thousand academic beds serving the population in northern Israel. Included were children aged < 18 years with clinically and laboratory-confirmed influenza infection admitted to the hospital between September 2009 and May 2020. Patients with poor data collection that precluded meaningful interpretation were excluded.

Data extracted

Results

A total of 1077 children were found to have laboratory-confirmed influenza infection with influenza A in 797 cases and influenza B in 286 cases. Six children with influenza A and influenza B coinfection were excluded to maintain a comparison between two pure groups with different influenza types, two of which were younger than 2 year the minimal age for administration of live attenuative influenza vaccine (LAIV) and one patient presented when the LAIV vaccine was out of use in Israel during the

Discussion

This study has shown that approximately one-third of hospitalized children with influenza infection have an unfavorable outcome and that predictors at admission can help identify patients at increased risk for such an outcome. Oxygen desaturation < 90%, underlying condition, elevated CRP, and influenza A serotype were associated with increased risk of an unfavorable outcome. Patients with influenza A were younger, more prone to oxygen desaturation < 90%, and had higher rates of pneumonia and

Conclusions

Unfavorable outcomes of influenza infection are not uncommon. Influenza A is an independent risk factor for an unfavorable outcome, along with comorbid conditions, elevated inflammatory markers and hypoxemia at admission. These data, available shortly after admission, can help predict disease progression and lead pediatricians make better calculated decisions about best the management. Together with other predictors reported in the literature, and others that may be published in the future, an

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

I would like to express my gratitude to everyone who took part in this project.

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