Impact of congenital heart disease on outcomes among pediatric patients hospitalized for influenza infection

Abstract

Background Young children and those with chronic medical conditions are at risk for complications of influenza including cardiopulmonary compromise. Here we aim to examine risks of mortality, clinical complications in children with congenital heart disease (CHD) hospitalized for influenza. Methods We analyzed data from in-hospital pediatric patients from 2003, 2006, 2009, 2012 and 2016 using the nationally representative Kids Inpatient Database (KID). We included children 1 year and older and used weighted data to compare the incidence of in-hospital mortality and rates of complications such as respiratory failure, acute kidney injury, need for mechanical ventilation, arrhythmias and myocarditis. Results Data from the KID estimated 125,470 children who were admitted with a diagnosis of influenza infection. Out of those, 2174(1.73%) patients had discharge diagnosis of CHD. Children with CHD who required hospitalization for influenza had higher in-hospital mortality (2.0% vs 0.5%), with an adjusted OR (aOR) of 2.8 (95% CI: 1.7–4.5). Additionally, acute respiratory failure and acute kidney failure were more likely among patients with CHD, with aOR of 1.8 (95% CI: 1.5–2.2) and aOR of 2.2 (95% CI: 1.5–3.1), respectively. Similarly, the rate of mechanical ventilatory support was higher in patients with CHD compared to those without, 14.1% vs 5.6%, aOR of 1.9 (95% CI: 1.6–2.3). Median length of hospital stay in children with CHD was longer than those without CHD [4 (IQR: 2–8) days vs. 2 (IQR: 2–4) days]. Outcomes were similar between those with severe vs non-severe CHD. Conclusions Children with CHD who require hospital admission for influenza are at significantly increased risk for in-hospital mortality, morbidities, emphasizing the need to reinforce preventative measures (e.g. vaccination, personal hygiene) in this particularly vulnerable population.

Hematological indices in pediatric patients with acyanotic congenital heart disease: a cross-sectional study of 248 patients

“…Numerous studies have indicated that viral respiratory infections, including influenza and COVID-19, impose a higher risk of mortality, a longer duration of hospitalization, and more complications and economic costs in patients with CHD than the general population [6,[37][38][39].…”

How Comorbidities Affect Hospitalization from Influenza in the Pediatric Population

“…Similarly, other studies reported increased complications in influenza infections associated with heart disease [ 18 , 19 ]. Although it is more common in adults, children with heart disease who are admitted to the hospital for influenza are at an increased risk for severe outcomes, such as in-hospital mortality and morbidities [ 20 ]. Unsurprisingly, children with hematologic disorders and other immune-suppression disorders were also more prone to experience severe influenza symptoms and be admitted, while children with psychiatric disorders experienced a longer length of hospital stay [ 21 ].…”

Influenza Vaccination in Patients With Congenital Heart Disease in the Pre-COVID-19 Era: Coverage Rate, Patient Characteristics, and Outcomes

“…21 When admitted to the hospital for influenza, such children are at significantly increased risk for in-hospital mortality, acute respiratory failure, acute kidney injury, need for invasive and noninvasive mechanical ventilation, myocarditis, and need for extracorporeal membrane oxygenation. 22 Understandably, this corresponded with a higher length of stay. 22 These complications were found to be independent of the severity of the CHD, indicating that children and adolescents with mild or moderate heart defects also benefit from vaccination.…”

“…22 Understandably, this corresponded with a higher length of stay. 22 These complications were found to be independent of the severity of the CHD, indicating that children and adolescents with mild or moderate heart defects also benefit from vaccination. 22 The predictors for vaccination were the complexity of the heart defect, a higher age, genetic syndromes, and a history of cardiac interventions.…”