Neurological and Neuromuscular Disease as a Risk Factor for Respiratory Failu

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Neurological and Neuromuscular Disease as a Risk Factor for

Respiratory Failure in Children Hospitalized With Influenza Infection

Journal of the American Medical Association

Vol. 294 No. 17, November 2, 2005

http://jama.ama-assn.org/cgi/content/abstract/294/17/2188?etoc

Ron Keren, MD, MPH; Theoklis E. Zaoutis, MD, MSCE; Carolyn B.

Bridges, MD; Guillermo Herrera, MD, MBA; Barbara M. , MBChB;

B. Wheeler, MD; J. Licht, MD; Xian Qun Luan, MS; E.

Coffin, MD, MPH

Context The Advisory Committee on Immunization Practices (ACIP)

recommends annual influenza vaccination for children with certain

chronic medical conditions to prevent serious complications of

influenza infection. Little is known about the relative contribution

of each of these chronic medical conditions to the development of

serious influenza-associated complications.

Objective To identify chronic medical conditions that are associated

with respiratory failure in children hospitalized with community-

acquired laboratory-confirmed influenza.

Design, Setting, and Patients A retrospective cohort study of

patients aged 21 years or younger hospitalized at The Children's

Hospital of Philadelphia with community-acquired laboratory-confirmed

influenza during 4 consecutive influenza seasons (June 2000 through

May 2004). We examined 9 ACIP-designated high-risk chronic medical

conditions and 3 additional chronic medical conditions (neurological

and neuromuscular disease [NNMD], gastroesophageal reflux disease

[GERD], and history of prematurity) that in recent studies have been

associated with influenza hospitalization and severe influenza-

related complications.

Main Outcome Measures Rate and odds ratio (OR) of respiratory

failure, defined as need for mechanical ventilation.

Results Of 745 children hospitalized with community-acquired

laboratory-confirmed influenza, 322 (43%) had 1 or more ACIP-

designated high-risk chronic medical conditions. Neurological and

neuromuscular disease, GERD, and history of prematurity were present

in 12%, 14%, and 3%, of children, respectively. Thirty-two children

(4.3%) developed respiratory failure. In multivariate logistic

regression analyses, conditions associated with respiratory failure

included NNMD (OR, 6.0; 95% confidence interval [CI], 2.7-13.5),

chronic pulmonary disease other than asthma (OR, 4.8; 95% CI, 1.5-

15.1), and cardiac disease (OR, 4.0; 95% CI, 1.6-10.2). The predicted

probabilities of respiratory failure derived from the multivariate

model were 12% (95% CI, 7%-20%), 9% (95% CI, 3%-23%), and 8% (95% CI,

4%-18%) for children with NNMD, chronic pulmonary disease, and

cardiac disease, respectively.

Conclusions These results support the ACIP's recent decision to add

NNMD to the list of conditions for which annual influenza vaccine is

recommended in children. Neurologists and primary care pediatricians

should be alerted to the increased risk of respiratory failure and

the importance of influenza vaccination in children with NNMD.

Author Affiliations: Division of General Pediatrics, Pediatric

Generalist Research Group (Dr Keren), Division of Infectious Diseases

(Drs Zaoutis, Wheeler, and Coffin), Division of Neurology (Dr Licht),

and Division of Biostatistics and Epidemiology (Mr Luan), Department

of Medicine, The Children's Hospital of Philadelphia; Center for

Clinical Epidemiology and Biostatistics, University of Pennsylvania

School of Medicine (Drs Keren and Zaoutis); Leonard Institute

of Health Economics, University of Pennsylvania (Dr Keren);

Philadelphia Department of Public Health (Dr ), Philadelphia,

Pa; and National Immunization Program, Centers for Disease Control

and Prevention, Atlanta, Ga (Drs Bridges and Herrera).