546 - Pediatric Patients with Acute Flaccid Myelitis: Respiratory and Neurologic Outcomes

Poster Number: 546
Publication Number: 546.139

Dimple Patel, Kaiser Permanente Oakland Medical Center, Union City, CA, United States; Shiyun Zhu, Kaiser Permanente - Oakland Medical Center, Oakland, CA, United States; Miranda Ritterman Weintraub, Kaiser Permanente - Oakland Medical Center, Oakland, CA, United States; Miranda Kane, Kaiser Permanente - Oakland Medical Center, Alamo, CA, United States

Background: Acute flaccid myelitis (AFM) is an infection mediated neurologic condition that presents with acute onset flaccid limb weakness. This condition primarily affects children and has been linked to viral etiologies, specifically enterovirus. Though most patients fully recover, those severely affected can develop respiratory failure and prolonged paralysis.

Objective: This study of pediatric patients with AFM assessed respiratory and neurologic outcomes according to respiratory failure at time of diagnosis.

Design/Methods: This is a retrospective study using an established cohort of 28 pediatric patients with AFM between 2011 and 2016. Patients were followed from AFM diagnosis, up until death, membership termination or end of follow-up (12/31/2020). Degree of respiratory support and respiratory complications were obtained. Modified Rankin Scores (MRS) were used to estimate neurologic recovery. Data was extracted electronically or by chart review and summarized using descriptive statistics.

Results: Of the 28 patients, there was one patient death and five membership terminations. The median follow-up time was 5.2 years (interquartile range: 4.03-6.75). Eight patients (28.6%) had respiratory failure during the index hospitalization, requiring high flow nasal cannula, bilevel positive airway pressure ventilation or mechanical ventilation (Table). Findings were stratified based on whether respiratory failure occurred during index hospitalization. Among children with respiratory failure, the incidence rate of requiring follow-up respiratory support was 0.15 cases per person-year. Children without respiratory failure did not require follow-up respiratory support. In addition, compared to children without respiratory failure, those with respiratory failure had higher MRS (mean difference 1.38, 95% confidence interval (CI): 0.31, 2.26) and higher rate of respiratory related emergency and in-hospital visits (rate ratio: 1.78, 95% CI: 1.17, 2.72).Conclusion(s): This descriptive analysis found that pediatric patients with AFM who experienced respiratory failure at diagnosis may need long-term respiratory support, have higher healthcare utilization, and exhibit prolonged neurologic deficits. This is evidenced by the increased rates of follow-up respiratory support and respiratory related visits, as well as a higher MRS indicating residual disability. We are expanding the years of this project to 2019 to increase our sample size and gain more specificity in the overall incidence rate, risk factors, complications, and outcomes of pediatric patients with AFM.
CV Dimple PatelCV - Dimple Patel 9.23.2021.pdf