Influenza A (pH1N1) infection in children admitted to a pediatric intensive care unit: differences with other respiratory viruses.
OBJECTIVE
To describe the clinical features of patients admitted to the pediatric intensive care unit (PICU) with acute lower respiratory tract infection (LRTI) attributable to influenza A pH1N1 virus and compare them with those admitted with LRTI due to other viral pathogens.


METHODS
Retrospective, observational, comparative study.


METHODS
PICU in a university-affiliated, tertiary-care, pediatric hospital.


METHODS
Patients aged >1 month with acute viral LRTI admitted to the PICU who met the following criteria: 1) influenza A pH1N1 virus infection detected between June 1, 2009 and July 16, 2009; and 2) patients with LRTI due to other viral pathogens infection detected in the same period of the year 2008 plus patients with 2009 influenza A non-pH1N1 infection.


METHODS
None.


RESULTS
We evaluated age, weight, gender, length of hospital stay before PICU admission, length of PICU stay, underlying disease, clinical diagnosis, severity, complications, treatment, risk of death, mortality, and cause of death. We identified 30 patients with acute LRTI due to influenza A pH1N1 virus (group 1) and 62 patients with LRTI due to other viral pathogens (group 2). Relevant characteristics in group 1: 59% of patients were aged >2 yrs. Median length of PICU stay was 15 days. An underlying condition was present in 83% of the patients. None of them had bronchiolitis on PICU admission; 12 (40%) had bilateral pneumonia; 15 (50%) had acute respiratory distress syndrome; and nine (30%) had shock. Twenty-nine patients required mechanical ventilation (96.6%); only one required extracorporeal membrane oxygenation; and 19 (63%) had respiratory complications. Six (20%) children died. When both groups were compared, patients with influenza A pH1N1 infection were older; pneumonia, acute respiratory distress syndrome, and shock were more frequently seen at the time of PICU admission, although length of stay and mortality were similar.


CONCLUSIONS
Patients with influenza A pH1N1 respiratory virus infection presented with more severe illness. Outcomes were similar in both groups.
Sasbón
Jorge S
JS
Pediatric Intensive Care Unit, Hospital de Pediatría Dr. J. P. Garrahan, Buenos Aires, Argentina. jsasbon@garrahan.gov.ar
Centeno
Mónica A
MA
García
Mauro D
MD
Boada
Nancy B
NB
Lattini
Bettina E
BE
Motto
Eduardo A
EA
Zuázaga
Marcela A
MA
Acebedo
Viviana V
VV
Truszkowski
Martín E
ME
Filippini
Silvia
S
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000503:physiopathology* / Q000821:virology; D015278:Intensive Care Units, Pediatric; D008297:Male; D012137:Respiratory System / Q000821:virology*; D012189:Retrospective Studies