Background: Children with neurologic/neuromuscular disorders (NNMD) may have impaired lung or muscle function, resulting in severe illness from respiratory viral infections. We describe clinical outcomes and respiratory pathogen detections in children with NNMD hospitalized with severe acute respiratory illness (SARI).
Methods: Surveillance for patients with SARI was conducted at 3 hospitals in the Minneapolis/St. Paul metropolitan area. Respiratory specimens collected from SARI patients were tested for 22 respiratory pathogens by RT-PCR. Medical records were reviewed to collect demographic and clinical information. We compared severe outcomes (intensive care unit admission, mechanical ventilation, or death) and length of stay (LOS) by pathogen detection among 3 SARI patient groups: NNMD, other comorbidities, and no comorbidities. We used a multinomial logistic regression model to evaluate severe outcome and LOS by group, and Poisson regression to evaluate LOS by pathogen detection among children with NNMD, adjusting for age.
Results: From September 2013-June 2015, 3,128 children <18 years with SARI were identified: 530 (17%) had NNMD, 970 (31.0%) had other comorbidities, and 1,628 (52%) had no comorbidities. Children with NNMD were older than those with other or no comorbidities (median age 2.9, 1.6 and 0.6 years, respectively, p<0.001), and pathogen detection decreased with increasing age and was slightly less frequent among children with NNMD (Figure). In multivariable analysis, children with NNMD had a longer LOS (6.1 vs. 4.5 and 3.7 days, respectively, p<0.001) and were more likely to have a severe outcome (aRR=2.3, 95% CI: 1.7-3.0) compared to children with no or other comorbidities. Further, among children with NNMD, LOS was 26% longer when a pathogen was detected (95% CI: 16.7-35.6% p<0.001).
Conclusion: Children with SARI who have NNMD are at greater risk for severe outcome and a longer LOS, which may be further prolonged when a pathogen is detected. These children generally presented at an older age compared to other children, and accounted for about one-sixth of our SARI patients. A better understanding of the impact of respiratory-specific pathogens in patients with NNMD may help target preventive measures and improve outcomes.
S. S. Chaves, None
A. Steffens, None
K. Como-Sabetti, None
D. Boxrud, None
S. Bistodeau, None
A. Strain, None
B. L. Whitaker, None
R. Lynfield, None
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