Influenza-associated neurological complications in hospitalized previously healthy children: a retrospective study at a tertiary center in Saudi Arabia

<p><strong>Background: </strong>Influenza in children is usually a self-limited respiratory illness, but it can cause central nervous system (CNS) complications ranging from simple febrile seizures to acute necrotizing encephalopathy. We describe the prevalence, clinical features, and short-term outcomes of influenza-associated CNS complications in previously healthy children at a tertiary center in Saudi Arabia.</p> <p><strong>Methods: </strong>We conducted a retrospective chart review of children younger than 14 years admitted with laboratory-confirmed influenza to King Abdullah Specialized Children's Hospital, Jeddah, Saudi Arabia, between November 2016 and December 2023. Children with a pre-existing CNS comorbidity or concurrent COVID-19 were excluded. Demographic, clinical, laboratory, and outcome data were extracted from the hospital's electronic health record (BESTCare) and analyzed descriptively.</p> <p><strong>Results: </strong>Of 509 children admitted with confirmed influenza, 449 had no pre-existing CNS comorbidity, and 19 of these (4.2%; 95% CI 2.6&ndash;6.5%) presented with CNS symptoms. All 19 had seizures, most often generalized tonic-clonic (15/19, 79%), and all had a normal neurological examination in the emergency department. Influenza A was detected in 16 children (84%), including one co-detection with influenza B and rhinovirus. Neuroimaging (7/19) and cerebrospinal fluid studies (8/19) were normal in all children tested, and all blood cultures were negative. Discharge diagnoses were simple febrile seizure (12, 63%), complex febrile seizure (3, 16%), and clinically diagnosed meningitis or meningoencephalitis (4, 21%). The median length of stay was 3 days (IQR 3), and no child died.</p> <p><strong>Conclusion: </strong>In previously healthy children hospitalized with influenza at our center, CNS involvement was uncommon, consisted of seizures, and had good short-term outcomes. These data add to the limited regional evidence but come from a small single-center sample and need confirmation in larger, multicenter studies.</p>