• Pierre Cleuziou, Florence Renaldo, Sylvain Renolleau, Etienne Javouhey, Pierre Tissieres, Pierre-Louis Léger, Jean Bergounioux, Isabelle Desguerre, Stéphane Dauger, Michaël Levy, and Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP).
• Pediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), and Université de Paris, Paris, France.
• Pediatr Crit Care Me. 2021 Nov 1; 22 (11): e582e587e582-e587.

ObjectivesTo describe and estimate the mortality rate of severe influenza-associated encephalopathy/encephalitis among children admitted to PICUs.DesignMulticenter retrospective study.SettingTwelve French PICUs.PatientsAll children admitted for influenza-associated encephalopathy/encephalitis between 2010 and 2018 with no severe preexisting chronic neurologic disorders and no coinfection potentially responsible for the disease.InterventionNone.Measurements And Main ResultsWe collected the clinical presentation; laboratory, electroencephalographic, and MRI findings; and treatments used in the PICU. The primary outcome was mortality. The secondary outcomes included sequelae at discharge and last follow-up. We included 41 patients with a median (interquartile range) age of 4.7 years (2.5-8.2 yr). The main reasons for admission were altered consciousness (59%) and status epilepticus (34%); 48% of patients had meningitis, and one third had acute necrotizing encephalopathy on MRI. Mechanical ventilation was required in 73% of patients and hemodynamic support in 24%. The use of specific treatments was variable; steroids were given to 49% of patients. Seven patients (17%) died in the PICU. Median (interquartile range) PICU stay length was 7 days (2-13 d), and total hospital length of stay was 23 days (7-33 d). On hospital discharge, 49% (n = 20) had neurologic sequelae, with 27% (n = 11) having severe disabilities defined by modified Rankin Score greater than or equal to 4.ConclusionsChildren requiring PICU admission for influenza-associated encephalopathy/encephalitis have high mortality and morbidity rates. The management remains highly variable due to the lack of guidelines.Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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