Published online April 2, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. 740-748 (doi:10.1542/peds.2006-2679)

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ARTICLE

Incidence, Complications, and Risk Factors for Prolonged Stay in Children Hospitalized With Community-Acquired Influenza

Susan E. Coffin, MD, MPH^a, Theoklis E. Zaoutis, MD, MSCE^a, Anna B. Wheeler Rosenquist, MD^a, Kateri Heydon, MS^a, Guillermo Herrera, MD, MBA^b, Carolyn B. Bridges, MD^b, Barbara Watson, MBChB^c, Russell Localio, PhD^d, Richard L. Hodinka, PhD^e and Ron Keren, MD, MPH^f

^f Divisions of General Pediatrics
^a Infectious Diseases
^e Department of Anatomic Pathology and Clinical Laboratories, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
^d Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
^c Department of Public Health
^b National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia

OBJECTIVES. Few studies have examined the characteristics and clinical course of children hospitalized with laboratory-confirmed influenza. We sought to (1) estimate the age-specific incidence of influenza-related hospitalizations, (2) describe the characteristics and clinical course of children hospitalized with influenza, and (3) identify risk factors for prolonged hospitalization.

PATIENTS AND METHODS. Children 21 years of age hospitalized with community-acquired laboratory-confirmed influenza at a large urban children's hospital were identified through review of laboratory records and administrative data sources. A neighborhood cohort embedded within our study population was used to estimate the incidence of community-acquired laboratory-confirmed influenza hospitalizations among children <18 years old. Risk factors for prolonged hospitalization (>6 days) were determined by using logistic regression.

RESULTS. We identified 745 children hospitalized with community-acquired laboratory-confirmed influenza during the 4-year study period. In this urban cohort, the incidence of community-acquired laboratory-confirmed influenza hospitalization was 7 per 10000 child-years of observation. The median age was 1.8 years; 25% were infants <6 months old, and 77% were children <5 years old. Many children (49%) had a medical condition associated with an increased risk of influenza-related complications. The incidence of influenza-related complications was higher among children with a preexisting high-risk condition than for previously healthy children (29% vs 21%). However, only cardiac and neurologic/neuromuscular diseases were found to be independent risk factors for prolonged hospitalization.

CONCLUSIONS. Influenza is a common cause of hospitalization among both healthy and chronically ill children. Children with cardiac or neurologic/neuromuscular disease are at increased risk of prolonged hospitalization; therefore, children with these conditions and their contacts should be a high priority to receive vaccine. The impact on pediatric hospitalization of the new recommendation to vaccinate all children 6 months to <5 years old should be assessed.

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Key Words: influenza • child • epidemiology

Abbreviations: LCI—laboratory-confirmed influenza • CA—community-acquired • CHOP—Children's Hospital of Philadelphia • ICD-9—International Classification of Diseases, Ninth Revision • SPIA—solid-phase immunoassay • DFA—direct fluorescent antibody assay • ACIP—Advisory Committee on Immunization Practices • NNMD—neurologic or neuromuscular disease • CDC—Centers for Disease Control and Prevention • LOS—length of stay • CI—confidence interval • OR—odds ratio

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Accepted Nov 14, 2006.

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