Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders

• Type of Material: Article
• Authors: Alexander Millman, Emory University; Lyn Finelli, Centers for Disease Control and Prevention; Anna M. Bramley, Centers for Disease Control and Prevention; Georgina Peacock, Centers for Disease Control and Prevention; Derek J. Williams, Vanderbilt University; Sandra R. Arnold, University of Tennessee; Carlos G. Grijalva, Vanderbilt University; Evan Anderson, Emory University; Jonathan A. McCullers, University of Tennessee; Krow Ampofo, University of Utah; Andrew T. Pavia, University of Utah; Kathryn M. Edwards, Vanderbilt University; Seema Jain, Centers for Disease Control and Prevention
• Language: English
• Date: 2016-06-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpeds.2016.02.049
• Title of Journal or Parent Work: Journal of Pediatrics
• ISSN: 0022-3476
• Volume: 173
• Start Page: 188
• End Page: +
• Grant/Funding Information: The Etiology of Pneumonia in the Community (EPIC) study is supported by the Influenza Division in the National Center for Immunizations and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC) through cooperative agreements with each study site and was based on a competitive research funding opportunity (Utah: U18IP000491; Nashville: U18IP000488; and Memphis: U18IP000489).; S.A. is supported by Glaxo Smith Kline. E.A. is supported by MedImmune, Roche, and Abbvie. K.A. is supported by BioFire Diagnostics, Inc (formerly Idaho Technology, Inc) on grants from the National Institutes of Health (Clinical Trial NCT01878383). A.P. is supported by Antimicrobial Therapy Inc, Medscape Inc, and BioFire Diagnostics Inc. K.E. is supported by Vanderbilt University from Novartis.
• Keywords: CEREBRAL-PALSY; Science & Technology; RECOMMENDATIONS; DISEASE; IMMUNIZATION PRACTICES ACIP; OROPHARYNGEAL ASPIRATION; 2009 PANDEMIC INFLUENZA; UNITED-STATES; Pediatrics; Life Sciences & Biomedicine; IMPAIRMENT; DEATHS; ADVISORY-COMMITTEE
• Research Categories: Biology, Neuroscience; Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Objective: To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions. Study design: Children <18 years old hospitalized with clinical and radiographic CAP were enrolled at 3 US children's hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses. Results: From January 2010-June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age. Conclusions: Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders.