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Youngsters could also be extra prone to survive a uncommon, doubtlessly deadly influenza complication in the event that they obtain fast remedy for mind swelling and excessive immune responses, a Stanford Medication-led report discovered.
The researchers hope to boost consciousness concerning the situation, known as influenza-associated acute necrotizing encephalopathy, and to tell mother and father and physicians about its prevention and remedy. Flu vaccines are a key protecting technique for ANE and different extreme flu issues in children, in response to the report, which is printed in JAMA.
“Acute necrotizing encephalopathy is the most severe flu complication, but it’s only the tip of the iceberg for what flu can do,” mentioned co-senior creator Keith Van Haren, MD, affiliate professor of neurology and neurological sciences and of pediatrics. Van Haren can also be a pediatric neurologist at Lucile Packard Youngsters’s Hospital Stanford.
“Flu causes all kinds of complications, including other forms of brain swelling, as well as pneumonia and respiratory failure. Vaccines really do help protect wonderfully against all those complications.”
Influenza-associated acute necrotizing encephalopathy causes mind swelling and a runaway immune response, a mixture that may be deadly. As outlined within the report, the researchers analyzed 41 instances of ANE that occurred throughout the nation from 2023 to 2025, an unusually excessive quantity tied to extreme flu seasons.
Among the many instances within the report, 27% of affected youngsters died. Of the survivors, 63% nonetheless had average to extreme incapacity three months after they grew to become sick. Receiving fast, focused care in a pediatric intensive care unit was related to a higher likelihood of restoration.
“It is essential that doctors promptly identify patients with ANE to ensure that these children can receive rapid, intensive care at hospitals that offer advanced neurocritical care and have experts familiar with immunomodulating medications,” mentioned co-senior creator Thomas LaRocca, MD, Ph.D., a scientific assistant professor and a pediatric crucial care drugs specialist at Packard Youngsters’s.
The specter of flu
“Flu is notoriously dangerous for kids; it always has been,” Van Haren mentioned, noting that youngsters youthful than 5 years face the very best threat of great sickness or demise.
The examine’s lead authors are Andrew Silverman, MD, and Rachel Walsh, MD, each of whom have been residents in pediatric neurology at Stanford Medication when the mission started.
Silverman is now a medical fellow at Weill Cornell Medical Faculty, and Walsh is now a fellow at Boston Youngsters’s Hospital and Harvard Medical Faculty. Van Haren and LaRocca share senior authorship of the examine with Molly Wilson-Murphy, MD, of Boston Youngsters’s Hospital and Harvard Medical Faculty.
“For clinicians, the takeaway from our report is that early, intensive management of brain swelling and the immune response really seemed to help children with this condition recover,” Van Haren mentioned.
Crucial factor that folks can do is be sure that youngsters obtain their annual flu vaccines, he mentioned, noting that the vaccines drastically scale back a toddler’s likelihood of turning into severely sick with flu.
Extra instances in a foul flu season
Van Haren, LaRocca and their colleagues started investigating ANE in 2024 as a result of they observed the situation was on the rise. Sometimes, they see one case yearly or two at Packard Youngsters’s.
Throughout the extreme 2024–25 flu season, through which the predominant circulating pressure of influenza A success children particularly onerous, they handled 4 youngsters with ANE and heard reviews from colleagues of instances elsewhere in Northern California.
The workforce initiated a nationwide inquiry to educational societies, state and federal public well being businesses, and pediatric specialists throughout the nation to ask if different establishments have been experiencing an analogous uptick—the reply was sure—and to request instances to research. In whole, 41 instances from 23 hospitals throughout america met the standards for inclusion within the report.
The median age of the youngsters with ANE was 5 years. Thirty-nine youngsters have been contaminated with influenza A; two had influenza B. Most kids had been wholesome, with no important medical historical past, earlier than contracting the flu. Among the many 38 ANE instances for which the kid’s vaccination historical past was identified, solely six had obtained flu vaccines throughout the season they grew to become sick. On the onset of their sickness, all sufferers had mind swelling, 95% had fevers and 68% had seizures.
Eleven sufferers (27%) died of ANE, eight inside every week of admission to the hospital. Sufferers died attributable to swelling and herniation of the mind. Solely one of many sufferers who died had obtained a flu vaccine.
Sufferers’ median keep within the intensive care unit was 11 days, and their median whole hospital keep was 22 days. The 30 youngsters who survived skilled various levels of long-term results; some made full recoveries, whereas others didn’t.
Utilizing reviews collected for as much as 90 days after the youngsters grew to become sick, the researchers noticed that of the 30 survivors, 19 sufferers regained the power to sit down, 16 sufferers may stand independently and 13 may stroll independently.
Higher-than-expected outcomes
“The number of kids who had pretty good outcomes surprised me; it was better than I thought it would be,” Van Haren mentioned, noting that ANE is regarded by physicians as prone to be deadly.
“We identified ANE patients with a wide range of outcomes, from no residual neurological deficits to, unfortunately, fatal complications,” LaRocca mentioned.
“We saw that critical-care management of brain swelling, along with immune-modulating therapies such as plasma exchange and intravenous immunoglobulin, appeared helpful for patients who recovered.”
The immune therapies are vital as a result of the underlying downside in ANE contains an out-of-control immune response, Van Haren mentioned.
“It’s similar to the sepsis response, this massive burst of inflammation that becomes its own problem,” he mentioned. “It’s like the immune system is going into a panic attack.”
Giving steroids might help calm the immune system, as can plasma trade, which entails eradicating the affected person’s blood plasma in a course of just like kidney dialysis and changing it with plasma from a wholesome donor.
Additional analysis to raised perceive the pathophysiology of ANE and be taught extra about efficient therapies is warranted, LaRocca mentioned.
“For doctors, our message is that these kids can recover remarkably well, even if they appear gravely ill early in their course. Don’t give up,” Van Haren mentioned. “And for parents, it’s: Vaccinate!”
Flu is greater than fever, aches and pains, he added.
“We want to protect them from the deadly stuff,” Van Haren mentioned. “That’s what the vaccine can do.”
Extra data:
Influenza-Related Acute Necrotizing Encephalopathy in U.S. Youngsters, JAMA (2025). jamanetwork.com/journals/jama/ … 1001/jama.2025.11534
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Stanford College Medical Middle
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Uncommon, severe flu complication in children wants fast remedy, examine finds (2025, July 30)
retrieved 30 July 2025
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