Neurological sequelae of 2009 influenza A (H1N1) in children: a case series observed during a pandemic

Pediatr Crit Care Med. 2010 Mar;11(2):179-84. doi: 10.1097/PCC.0b013e3181cf4652.


Objective: To outline a series of cases demonstrating neurologic complications in children with Influenza infection. The ongoing 2009 influenza A (H1N1) presents significant challenges to the field of pediatric critical care and requires increased awareness of new presentations and sequelae of infection. Since World Health Organization declared a H1N1 pandemic, much attention has been focused on its respiratory manifestations of the illness, but limited information regarding neurologic complications has been reported.

Design: Case series.

Setting: Pediatric intensive care unit of a tertiary care medical facility.

Patients: Four children admitted to the pediatric intensive care unit between March and November 2009 at the Children's Hospital of Pittsburgh with altered mental status and influenza infection.

Interventions: None.

Measurements and main results: The clinical course was extracted by chart review and is summarized. All children demonstrated a coryzal prodrome, fever, and altered level of consciousness at admission, and one child presented with clinical seizures. Diagnostic studies performed to establish a diagnosis are summarized. All children had abnormal electroencephalograms early in their intensive care unit course and 50% had abnormal imaging studies. All children survived but 50% had neurologic deficits at hospital discharge.

Conclusion: We conclude that 2009 influenza A (H1N1) can cause significant acute and residual neurologic sequelae. Clinicians should consider Influenza within a comprehensive differential diagnosis in children with unexplained mental status changes during periods of pandemic influenza.

Publication types

  • Case Reports

MeSH terms

  • Child
  • Child, Preschool
  • Female
  • Humans
  • Influenza A Virus, H1N1 Subtype / pathogenicity*
  • Influenza, Human / complications*
  • Intensive Care Units, Pediatric
  • Male
  • Nervous System Diseases / physiopathology*
  • Nervous System Diseases / virology*
  • Pennsylvania