[Characteristics of severely and critically ill children with 2009 influenza A (H1N1) virus infection].
OBJECTIVE
To analyze the clinical characteristics of severely and critically ill children with 2009 influenza A (H1N1) infection.


METHODS
Clinical data of 150 cases with 2009 influenza A (H1N1) virus infection confirmed with the use of a real-time polymerase-chain-reaction assay on nasopharyngeal swab specimens were analyzed.


RESULTS
Among 150 severely and critically ill children with 2009 influenza A (H1N1) virus infection, 103 were male, 47 were female; the median age was 5 years, 81(55%) were 5 years of age or older; 21 (14%) had underlying chronic diseases. The most common presenting symptoms were fever (95%), cough (89%), vomiting (23%), wheezing (19%), abdominal pain (16%), lethargy (7%), seizures (6%), myalgia (6%), and diarrhea (6%). The common laboratory abnormalities were increased or decreased white blood cells counts (40%), elevated of CRP (33%), LDH (29%), CK (25%) and AST (19%). Clinical complications included pneumonia (65%), encephalopathy (12%), myocarditis (5%), encephalitis (1%) and myositis (1%). All patients had received antibiotics before admission or on admission; 73% of patients had received oseltamivir treatment, 23% of patients had received corticosteroids; 32 (21%) were admitted to an ICU, 13 patients were intubated and mechanically ventilated. Fourteen patients with dyspnea who were irresponsive to the treatment experienced bronchoalveolar lavage with flexible bronchoscopy, and the branching bronchial casts were removed in 5 patients. Totally 145 (97%) patients were discharged, five (3%) died, three previously healthy patients died from severe encephalopathy, one patient died from ARDS, one previously healthy patient died from secondary fungal meningitis.


CONCLUSIONS
Severely and critically ill children with 2009 influenza A (H1N1) virus infection may occur mainly in older children without underlying chronic disease. The clinical spectrum and laboratory abnormality of the patients can have a wide range. Neurologic complications may be common and severe encephalopathy can lead to death in previously healthy children. Early use of bronchoalveolar lavage with flexible bronchoscopy may reduce death associated with pulmonary complications.
Department of Respiratory Diseases, Shenzhen Children's Hospital, Zunyi Medical College, Shenzhen 518026, China.
Zhi-wei
ZW
Lu
Ji-kui
JK
Deng
Yue-jie
YJ
Zheng
Yan-xia
YX
He
Wei-guo
WG
Yang
Ju-rong
JR
Wei
Jiao-sheng
JS
Zhang
Bo-ning
BN
Li
Xiao-nan
XN
Li
Ping
P
Song
Zhen-zhu
ZZ
Yu
Hui
H
Zhao
Li
L
Wang
Yi-jiao
YJ
Ma
Zheng-zhen
ZZ
Tang
Xiao-li
XL
Liu
Yu-zheng
YZ
Li
Cheng-rong
CR
Li
D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D008297:Male