Program Schedule

Clinical Characteristics And Outcomes among Children with Neurological Disorders Hospitalized with Community-acquired Pneumonia (CAP) in the Etiology of Pneumonia in the Community (EPIC) Study

Session: Poster Abstract Session: Clinical Respiratory Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • Millman_IDweek_poster.pdf (264.5 kB)
  • Background: Although children with neurological disorders are vulnerable to complications from respiratory infection, CAP epidemiology among these children is poorly understood.

    Methods:  Children <18 years hospitalized with clinical and radiographic CAP were enrolled in the CDC EPIC study in Memphis, Nashville, and Salt Lake City. Children residing in a chronic care facility and those with recent hospitalization, tracheostomy, or severe immunosuppression were excluded due to healthcare exposure. Neurological disorders were defined as cerebral palsy, spinal cord abnormalities, epilepsy, Down syndrome, developmental delay, and chromosomal and other disorders with primary neurological manifestation. We compared children with neurological disorders to those with other non-neurological co-morbidities and with children with no co-morbidities.

    Results:  From January 2010-June 2012, 2358 children with CAP were enrolled; 279 (12%) had a neurological disorder (54% with another co-morbidity), 968 (41%) had non-neurological co-morbidities only, and 1,111 (47%) had no co-morbidities. Children with neurological disorders were older, had longer hospital and intensive care unit (ICU) length of stay (LOS), and more ICU admissions, than children without neurological disorders; there were no differences in the proportion mechanically ventilated.

    Group 1

    Group 2

    Group 3



    Neurological disorder


    Non-neurological co-morbidity


    No co-morbidity


    Group 1 vs 2

    Group 1 vs 3

    Median age in years

    (interquartile range)

    5.9 (1.7-9.8)

    2.8 (1.3-6.2)

    1.8 (0.8-4.6)



    Congenital heart disease

    95 (34)

    104 (11)





    83 (30)

    696 (72)




    Hospital LOS >3 days

    153 (55)

    316 (33)

    357 (32)



    ICU admission

    102 (37)

    186 (19)

    209 (19)



    ICU LOS >3 days

    49/102 (48)

    66/186 (35)

    86/209 (41)



    Invasive mechanical


    34/102 (33)

    52/186 (28)

    79/209 (38)




    1 (0.4)

    0 (0)

    2 (0.2)



    *Values are No. (%) unless otherwise specified

    Conclusion:  When hospitalized with CAP, children with neurological disorders had a more severe course of illness, in terms of ICU admission and LOS, in comparison with children without neurological disorders, which may be independent of respiratory failure alone.

    Alexander J. Millman, MD1, Lyn Finelli, DrPH, MS2, Anna M. Bramley, MPH3, Georgina Peacock, MD, MPH4, Derek J. Williams, MD, MPH5, Sandra R. Arnold, MD6, Carlos G. Grijalva, MD, MPH7, Evan J. Anderson, MD8, Jonathan a. Mccullers, MD9, Krow Ampofo, MD10, Andrew Pavia, MD, FIDSA, FSHEA10, Kathryn Edwards, MD, FIDSA11 and Seema Jain, MD, MPH1, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, (3)Centers for Disease Control and Prevention (CDC), Atlanta, GA, (4)National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, (5)Vanderbilt University School of Medicine, Nashville, TN, (6)Le Bonheur Children's Hospital, Memphis, TN, (7)Preventative Medicine, Vanderbilt University School of Medicine, Nashville, TN, (8)Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, (9)St. Jude Children's Research Hospital, Memphis, TN, (10)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (11)Division of Pediatric Infectious Disease, Vanderbilt University Medical Center, Nashville, TN


    A. J. Millman, None

    L. Finelli, None

    A. M. Bramley, None

    G. Peacock, None

    D. J. Williams, None

    S. R. Arnold, None

    C. G. Grijalva, None

    E. J. Anderson, None

    J. A. Mccullers, None

    K. Ampofo, None

    A. Pavia, None

    K. Edwards, Novartis: Grant Investigator and Scientific Advisor, Research grant

    S. Jain, None

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