Comorbidity, secondary infections predict IMV need, death in children with influenza-related LRTI

Neutrophilia, lymphopaenia, secondary bacterial infections (SBIs) and presence of comorbidity are associated with severe clinical course, as well as death, in children with influenza-related lower respiratory tract infection (LRTI), a recent study has found.

Overall, 280 patients with LRTI were admitted to a hospital, with median hospitalization length of 9 days. Hospital stay tended to be longer among patients with congenital heart disease, neuromuscular disease, SBIs and late-onset antiviral treatment (p<0.05).

Of the patients, 57 (20.4 percent) were admitted to the paediatric intensive care unit and 48 (17.1 percent) required invasive mechanical ventilation (IMV). The following factors were independently associated with IMV support: SBIs, lymphopaenia, neutrophilia, immunosuppression and human bocavirus coinfection (p<0.05).

Eighteen patients died. The independent risk factors for mortality were as follows: SBIs, lymphopaenia and immunosuppression (p<0.05).

“Although several studies showed that antiviral treatment reduce hospitalization, complications and mortality, there is a lack of prospective trials, and patients for antiviral therapy should be carefully chosen by the clinician,” the authors said.

This retrospective study was performed in children hospitalized with influenza virus LRTI from 2008 to 2018. The authors collected data on demographic features, influenza type, viral coinfection, primary and SBIs, time of onset of antiviral treatment, comorbidities, hospitalization length, paediatric intensive care unit admission or IMV need, and mortality from medical records.

“Influenza virus is one of the most common respiratory pathogens for all age groups and may cause seasonal outbreaks,” the authors noted.