Paediatric anaesthesia & critical care
Influenza-Associated Acute Necrotizing Encephalopathy in US Children
Authors' conclusion
In this case series of children with influenza-associated ANE from the 2 most recent influenza seasons in the US, the condition was associated with high morbidity and mortality in this cohort of predominantly young and previously healthy children.
Study context
- Population
- US children (≤21 years) with influenza-associated acute necrotizing encephalopathy, October 2023–May 2025, 23 US hospitalsof 58 submitted cases
- Participants
- 41 children
- Outcome
- Presenting symptoms, vaccination history, laboratory and genetic findings, interventions, and clinical outcomes (modified Rankin Scale score, LOS, functional outcomes)
Methodological detailsmulticenter, longitudinal follow-up
- Multicenter
- Longitudinal follow-up
Main finding
As reported in the abstract
Clinical presentation and outcomes
- Fever
- 38 (93%)
- Encephalopathy
- 41 (100%)
- Seizures
- 28 (68%)
- No significant medical history
- 31 (76%)
- Medically complex
- 5 (12%)
- Influenza A
- 39 (95%)
- Influenza B
- 2
- Genetic risk alleles potentially related to acute necrotizing encephalopathy (ANE) (of 32 tested)
- 15 (47%)
- RANBP2 variants (of 32 tested)
- 11 (34%)
- Age-appropriate seasonal influenza vaccination (of 38 with history)
- 6 (16%)
- Median ICU LOS, days (IQR)
- 11 (4-19)
- Median hospital LOS, days (IQR)
- 22 (7-36)
- Died
- 11 (27%)
- Median time from symptom onset to death, days (IQR)
- 3 (2-4)
- Death primarily from cerebral herniation
- 91%
- At least moderate disability (modified Rankin Scale score ≥3) among 27 survivors with 90-day follow-up
- 63%
Observational data: associations, not effects.
Further findings
Laboratory deviations
- Elevated liver enzymes
- 78%
- Thrombocytopenia
- 63%
- Elevated cerebrospinal fluid protein
- 63%
Immunomodulatory treatments
- Methylprednisolone
- 95%
- Intravenous immunoglobulin
- 66%
- Tocilizumab
- 51%
- Plasmapheresis
- 32%
- Anakinra
- 5%
- Intrathecal methylprednisolone
- 5%
Original publication
Influenza-Associated Acute Necrotizing Encephalopathy in US Children. JAMA. Published 26 August 2025. doi:10.
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