Critically ill infants and children with influenza A (H1N1) in pediatric intensive care units in Argentina.
OBJECTIVE
To determine the epidemiological features, course, and outcomes of critically ill pediatric patients with Influenza A (H1N1) virus.


METHODS
Prospective cohort of children in pediatric intensive care units (PICUs) due to Influenza A (H1N1) virus infection.


METHODS
Seventeen medical-surgical PICUs in tertiary care hospital in Argentina.


METHODS
All consecutive patients admitted to the PICUs with influenza A (H1N1) viral infection from 15 June to 31 July 2009.


RESULTS
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).


CONCLUSIONS
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.
Unidad de Cuidados Intensivos Pediátricos, Hospital de Niños R Gutiérrez, Gallo 1330, CABA 1425, Buenos Aires, Argentina. Julioafarias@gmail.com
Julio A
JA
Farias
Analía
A
Fernández
Ezequiel
E
Monteverde
Nilda
N
Vidal
Pilar
P
Arias
María J
MJ
Montes
Gabriela
G
Rodríguez
Mariela
M
Allasia
Maria E
ME
Ratto
Roxana
R
Jaén
Claudia
C
Meregalli
Karina
K
Fiquepron
Ana R
AR
Calvo
Alejandro
A
Siaba
Lidia
L
Albano
Rossana
R
Poterala
Pablo
P
Neira
Andrés
A
Esteban
D001118:Argentina / Q000453:epidemiology; D015331:Cohort Studies; D016638:Critical Illness / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome