Critically ill infants and children with influenza A (H1N1) in pediatric intensive care units in Argentina
ABSTRACT To determine the epidemiological features, course, and outcomes of critically ill pediatric patients with Influenza A (H1N1) virus.
Prospective cohort of children in pediatric intensive care units (PICUs) due to Influenza A (H1N1) virus infection.
Seventeen medical-surgical PICUs in tertiary care hospital in Argentina.
All consecutive patients admitted to the PICUs with influenza A (H1N1) viral infection from 15 June to 31 July 2009.
Of 437 patients with acute lower respiratory infection in PICUs, 147 (34%) were diagnosed with influenza A (H1N1) related to critical illness. The median age of these patients was 10 months (IQR 3-59). Invasive mechanical ventilation was used in 117 (84%) on admission. The rate of acute respiratory distress syndrome (ARDS) was 80% (118 of 147 patients). Initial non-invasive ventilation failed in 19 of 22 attempts (86%). Mortality at 28 days was 39% (n = 57). Chronic complex conditions (CCCs), acute renal dysfunction (ARD) and ratio PaO(2)/FiO(2) at day 3 on MV were independently associated with a higher risk of mortality. The odds ratio (OR) for CCCs was 3.06, (CI 95% 1.36-6.84); OR for ARD, 3.38, (CI 95% 1.45-10.33); OR for PaO(2)/FiO(2), 4 (CI 95% 1.57-9.59). The administration of oseltamivir within 24 h after admission had a protective effect: OR 0.2 (CI 95% 0.07-0.54).
In children with ARDS, H1N1 as an etiologic agent confers high mortality, and the presence of CCCs in such patients increases the risk of death.
- SourceAvailable from: Mathias Altmann
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- "Neurodevelopmental disorders were reported for more than half of the children and in more than three fourths of those who died. These results are consistent with the results from other PICU-setting studies in which neurodevelopmental disorders were the first or second most prevalent risk factor (9–12). According to the surveillance system for pediatric deaths associated with pandemic (H1N1) 2009 in the United States, 92% of the children with high-risk medical conditions had neurodevelopmental disorders (22). "
ABSTRACT: In a hospital-based observational study in Germany, we investigated children admitted to pediatric intensive care units and deaths caused by confirmed pandemic (H1N1) 2009 to identify risk factors and outcomes in critically ill children. Ninety-three children were eligible for our study, including 9 with hospital-acquired infections. Seventy-five percent had underlying chronic medical conditions; neurodevelopmental disorders were most prevalent (57%). The proportion of patients having ≥1 risk factor increased with age in years (odds ratio 1.21, p = 0.007). Of 15 deaths, 11 occurred in a pediatric intensive care unit (case-fatality rate 12%, 95% confidence interval 6%-21%). Only 9% of the children had been vaccinated against pandemic (H1N1) 2009; all survived. Our results stress the role of underlying risk factors, especially neurodevelopmental disorders, and the need for improving preventive measures to reduce severe disease and adverse outcomes of pandemic (H1N1) 2009 in children.Emerging Infectious Diseases 02/2011; 17(2):186-92. DOI:10.3201/eid1702.101090 · 7.33 Impact Factor
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ABSTRACT: Hypoxemia was found to be a major cause of death from pandemic H1N1 2009 influenza (pH1N1) infection. There are limited data on factors associated with hypoxemia in children infected with pH1N1 influenza virus. Factors associated with hypoxemia were investigated using univariate and multivariate analysis in 76 hospitalized pediatric patients with laboratory-confirmed H1N1 influenza virus infection at Gyeongsang National University Hospital in Jinju, South Korea, from August 2009 to January 2010 by retrospective chart review. Hypoxemia occurred in 17 children (22%), of whom three were admitted to an intensive care unit and one died. Hypoxemic patients were significantly more likely to have a higher respiratory rate, pulse rate, white blood cell count (WBC), and C-reactive protein level, as well as a longer hospital stay. Respiratory rate and WBC count at admission were independently associated with hypoxemia as determined on multivariate analysis, and this association was found to be clinically significant. Although a higher WBC count and respiratory rate may not be specific for pHINI but represent the degree of disease severity for any infectious respiratory disease in general, clinicians can use these parameters at admission as useful, early indicators of disease severity in pediatric pH1N1 infection.Pediatrics International 12/2010; 53(5):622-5. DOI:10.1111/j.1442-200X.2010.03319.x · 0.73 Impact Factor
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ABSTRACT: This study describes the clinical course, treatment, and outcome of 13 critically ill children due to infection with new influenza A H1N1, admitted to 2 pediatric intensive care units (PICUs) in the northwestern part of the Netherlands. Retrospective case series, conducted in 2 PICUs in Amsterdam, the Netherlands. A total of 13 children with a new influenza A H1N1 infection were admitted at 2 Dutch PICUs. The majority of these children were 12 to 16 years old and had an underlying disease. All children required mechanical ventilatory support. Shock was present in 7 of 13 (54%) children. Two children were transferred to a supraregional PICU with facilities for extracorporeal membrane oxygenation. In a Dutch cohort of 13 critically ill children due to infection with new influenza (H1N1), respiratory (100%) and circulatory (54%) failure characterized the course of this infection in most of these children. All children survived.Clinical Pediatrics 01/2011; 50(1):69-72. DOI:10.1177/0009922810381426 · 1.26 Impact Factor