Faculty Collaboration Database

Association of Early Oseltamivir With Improved Outcomes in Hospitalized Children With Influenza, 2007-2020. JAMA Pediatr 2022 Nov 01;176(11):e223261

Date

09/20/2022

Pubmed ID

36121673

Pubmed Central ID

PMC9486642

DOI

10.1001/jamapediatrics.2022.3261

Scopus ID

2-s2.0-85138572189 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

IMPORTANCE: Oseltamivir is recommended for all children hospitalized with influenza, despite limited evidence supporting its use in the inpatient setting.

OBJECTIVE: To determine whether early oseltamivir use is associated with improved outcomes in children hospitalized with influenza.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter retrospective study included 55 799 children younger than 18 years who were hospitalized with influenza from October 1, 2007, to March 31, 2020, in 36 tertiary care pediatric hospitals who participate in the Pediatric Health Information System database. Data were analyzed from January 2021 to March 2022.

EXPOSURES: Early oseltamivir treatment, defined as use of oseltamivir on hospital day 0 or 1.

MAIN OUTCOMES AND MEASURES: The primary outcome was hospital length of stay (LOS) in calendar days. Secondary outcomes included 7-day hospital readmission, late (hospital day 2 or later) intensive care unit (ICU) transfer, and a composite outcome of in-hospital death or use of extracorporeal membrane oxygenation (ECMO). Inverse probability treatment weighting (IPTW) based on propensity scoring was used to address confounding by indication. Mixed-effects models were used to compare outcomes between children who did and did not receive early oseltamivir treatment. Outcomes were also compared within high-risk subgroups based on age, presence of a complex chronic condition, early critical illness, and history of asthma.

RESULTS: The analysis included 55 799 encounters from 36 hospitals. The median (IQR) age of the cohort was 3.61 years (1.03-8.27); 56% were male, and 44% were female. A total of 33 207 patients (59.5%) received early oseltamivir. In propensity score-weighted models, we found that children treated with early oseltamivir had shorter LOS (median 3 vs 4 days; IPTW model ratio, 0.52; 95% CI, 0.52-0.53) and lower odds of all-cause 7-day hospital readmission (3.5% vs 4.8%; adjusted odds ratio [aOR], 0.72; 95% CI, 0.66-0.77), late ICU transfer (2.4% vs 5.5%; aOR, 0.41; 95% CI, 0.37-0.46), and the composite outcome of death or ECMO use (0.9% vs 1.4%; aOR, 0.63; 95% CI, 0.54-0.73).

CONCLUSIONS AND RELEVANCE: Early use of oseltamivir in hospitalized children was associated with shorter hospital stay and lower odds of 7-day readmission, ICU transfer, ECMO use, and death. These findings support the current recommendations for oseltamivir use in children hospitalized with influenza.

Author List

Walsh PS, Schnadower D, Zhang Y, Ramgopal S, Shah SS, Wilson PM

Author

Patrick S. Walsh MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Antiviral Agents
Child
Child, Hospitalized
Child, Preschool
Female
Hospital Mortality
Hospitalization
Humans
Influenza, Human
Length of Stay
Male
Oseltamivir
Retrospective Studies