Premature Children at High Risk of Flu-Related Complications

Premature Baby in HospitalCurrent guidelines from the United States, United Kingdom, and World Health Organization (WHO) do not currently consider children born prematurely at high risk for flu-related complications. However, a new study calls the current guidelines into question after finding a great risk among premature children.

Influenza, or the flu, is a contagious respiratory illness caused by various flu viruses. Symptoms of the flu include fever, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue. Complications of the flu include pneumonia, bronchitis, sinus and ear infections, and death. Influenza is not the same as the stomach flu, which is characterized by nausea, vomiting, and diarrhea. The seasonal flu vaccine protects against the respiratory flu.

For the present study as published in the journal The Lancet Respiratory Medicine, researchers including Dr. Kay Wang of the University of Oxford sought to provide an evidence-based definition of children who are most at risk of complications from the flu.

As the researchers note, children with underlying health conditions are at greater risk for flu-related complications:

“Around 20% of children who present with influenza or influenza-like illness have at least one medical disorder, and the presence of comorbidities increases the rates of influenza-related hospital admissions almost six times in children aged 5 to 14 years. After being admitted to hospital, such at-risk patients are also at higher risk of further complications.”

WHO recommends that all individuals at high risk of flu-related complications be vaccinated against flu with the influenza vaccine.

To determine which children are at highest risk, the researchers analyzed 27 studies involving 14,086 children who visited a health care professional for the flu or a flu-like illness. Of the total children, 3,086 had diagnosed underlying medical conditions.

After assessing seven of the studies involving 3,142 children, the researchers discovered that children born prematurely — defined as birth before 37 weeks of gestation — were twice as likely to be hospitalized for flu-related complications than children without underlying medical conditions.

Comments Dr. Wang on the findings:

“Considering that around 10% (12.9 million) of the world’s babies are born prematurely – with preterm delivery rates of around 6% in Europe, 11% in North America, and 12% in Africa – it’s a significant public health issue and has major implications for policy makers.”

The researchers additionally found that children with more than one underlying medical condition were at even great risk for flu-related complications. Children with one underlying medical condition were 48% more likely to be hospitalized. Children with more than one condition were 78% more likely to be admitted to the hospital.

The present study also supports previous studies that found that children with neurological disorders, sickle cell disease, immunosuppression, and diabetes and children under the age of 2 were at greater risk of flu-related complications.

Based on the findings, the researchers argue that interventions to prevent influenza-related complications such as the influenza vaccine and antiviral medications should be prioritized in these groups of higher risk individuals.

In an accompanying editorial, Harish Nair of the University of Edinburgh in the UK and Marc-Alain Widdowson of the Centers for Disease Control and Prevention (CDC) add:

“Examples include the introduction, or increasing the uptake of, influenza and pneumococcal vaccination globally, immunization of mothers against influenza to protect very young infants, and exploration of other vaccine types, such as adjuvanted vaccines that may be more immunogenic and cross-protective against non-matched strains. Implementation of these options should not wait for the next influenza pandemic, but be explored now to prevent the disproportionate burden of seasonal influenza on susceptible children every year.”

The influenza vaccine including the flu shot and the flu mist can help prevent the flu as well as reduce the severity of symptoms and reduce the risk of flu-related complications.


Identification of children at risk of influenza-related complications in primary and ambulatory care: a systematic review and meta-analysis:
Preterm children at high risk of flu-related complications, study finds:

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