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.
Farias
Julio A
JA
Unidad de Cuidados Intensivos Pediátricos, Hospital de Niños R Gutiérrez, Gallo 1330, CABA 1425, Buenos Aires, Argentina. Julioafarias@gmail.com
Fernández
Analía
A
Monteverde
Ezequiel
E
Vidal
Nilda
N
Arias
Pilar
P
Montes
María J
MJ
Rodríguez
Gabriela
G
Allasia
Mariela
M
Ratto
Maria E
ME
Jaén
Roxana
R
Meregalli
Claudia
C
Fiquepron
Karina
K
Calvo
Ana R
AR
Siaba
Alejandro
A
Albano
Lidia
L
Poterala
Rossana
R
Neira
Pablo
P
Esteban
Andrés
A
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