OBJECTIVE: To describe the presentation, course, and outcome of critically ill children with novel H1N1 influenza disease. DESIGN: Retrospective case series. SETTING: Pediatric intensive care unit in an urban tertiary academic center. PATIENTS: Thirteen consecutive patients admitted between June 2009 and August 2009 and known or subsequently found to be infected with novel H1N1 influenza A. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Clinical, laboratory, and radiographic data were reviewed. The patients were predominantly male (62%), aged 5 months to 21 yrs, and most (92%) had known risk factors for severe disease. Direct fluorescent antibody testing had a high false-negative rate (62%) and delayed treatment in some cases. The respiratory illness presented clinically with both bronchoconstriction and alveolar consolidation to varying degrees. Bacterial superinfection occurred frequently (23%). Forty-six percent of patients required mechanical ventilation and 23% required inotropic support for hypotension. None of the patients in this series required extracorporeal membrane oxygenation. Intensive care unit length of stay did not differ between an early (within 48 hrs) oseltamivir treatment group (length of stay, 4.2 +/- 4.4 days) vs. a late treatment group (length of stay, 6.8 +/- 8.8 days). All patients survived to hospital discharge. CONCLUSIONS: Underlying chronic illness (especially respiratory illness) seems associated with critical novel H1N1 influenza disease in children. Respiratory manifestations are highly variable among patients and within a single patient involving both bronchoconstriction and alveolar disease. Therapies must be individualized and rapidly adjusted. The duration of critical illness was not different between early and late treatment groups. Whether this is reflective of sample size or indicative of the importance of therapeutic intervention at any time early during infection in critically ill patients is unclear. Bacterial superinfection was more common than previously reported for seasonal influenza A. Moderate novel H1N1 influenza disease, including respiratory failure and hypotension, had 100% survival in our series.
OBJECTIVE: To describe the presentation, course, and outcome of critically ill children with novel H1N1influenza disease. DESIGN: Retrospective case series. SETTING: Pediatric intensive care unit in an urban tertiary academic center. PATIENTS: Thirteen consecutive patients admitted between June 2009 and August 2009 and known or subsequently found to be infected with novel H1N1 influenza A. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Clinical, laboratory, and radiographic data were reviewed. The patients were predominantly male (62%), aged 5 months to 21 yrs, and most (92%) had known risk factors for severe disease. Direct fluorescent antibody testing had a high false-negative rate (62%) and delayed treatment in some cases. The respiratory illness presented clinically with both bronchoconstriction and alveolar consolidation to varying degrees. Bacterial superinfection occurred frequently (23%). Forty-six percent of patients required mechanical ventilation and 23% required inotropic support for hypotension. None of the patients in this series required extracorporeal membrane oxygenation. Intensive care unit length of stay did not differ between an early (within 48 hrs) oseltamivir treatment group (length of stay, 4.2 +/- 4.4 days) vs. a late treatment group (length of stay, 6.8 +/- 8.8 days). All patients survived to hospital discharge. CONCLUSIONS: Underlying chronic illness (especially respiratory illness) seems associated with critical novel H1N1influenza disease in children. Respiratory manifestations are highly variable among patients and within a single patient involving both bronchoconstriction and alveolar disease. Therapies must be individualized and rapidly adjusted. The duration of critical illness was not different between early and late treatment groups. Whether this is reflective of sample size or indicative of the importance of therapeutic intervention at any time early during infection in critically ill patients is unclear. Bacterial superinfection was more common than previously reported for seasonal influenza A. Moderate novel H1N1influenza disease, including respiratory failure and hypotension, had 100% survival in our series.
Authors: Adrienne G Randolph; Frances Vaughn; Ryan Sullivan; Lewis Rubinson; B Taylor Thompson; Grace Yoon; Elizabeth Smoot; Todd W Rice; Laura L Loftis; Mark Helfaer; Allan Doctor; Matthew Paden; Heidi Flori; Christopher Babbitt; Ana Lia Graciano; Rainer Gedeit; Ronald C Sanders; John S Giuliano; Jerry Zimmerman; Timothy M Uyeki Journal: Pediatrics Date: 2011-11-07 Impact factor: 7.124
Authors: Trung Nguyen; Ursula G Kyle; Nancy Jaimon; M Hossein Tcharmtchi; Jorge A Coss-Bu; Fong Lam; Jun Teruya; Laura Loftis Journal: Crit Care Med Date: 2012-12 Impact factor: 7.598
Authors: Mathias Altmann; Lena Fiebig; Jana Soyka; Rüdiger von Kries; Manuel Dehnert; Walter Haas Journal: Emerg Infect Dis Date: 2011-02 Impact factor: 6.883
Authors: Stuart R Dalziel; John Md Thompson; Charles G Macias; Ricardo M Fernandes; David W Johnson; Yehezkel Waisman; Nicholas Cheng; Jason Acworth; James M Chamberlain; Martin H Osmond; Amy Plint; Paolo Valerio; Karen Jl Black; Eleanor Fitzpatrick; Amanda S Newton; Nathan Kuppermann; Terry P Klassen Journal: BMJ Date: 2013-08-12