title: High mortality in patients with influenza A pH1N1 2009 admitted to a pediatric intensive care unit: a predictive model of mortality.
abstract: OBJECTIVE
  To describe the clinical characteristics and outcome of patients admitted to pediatric intensive care with influenza A (pH1N1) 2009 in Argentina.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Thirteen pediatric intensive care units in Argentina.
  
  
  METHODS
  One hundred and forty-two patients with confirmed or suspected influenza A (H1N1).
  
  
  METHODS
  None.
  
  
  RESULTS
  We included 142 critically ill patients. The median age was 19 months (range, 2-110 months) with 39% of the patients <24 months of age. Ninety-nine patients (70%) had an underlying disease. Influenza A (pH1N1) 2009 infection was confirmed in 90 patients and the remaining 52 had a positive direct immunofluorescence assay for influenza A. The median length of stay in the pediatric intensive care unit was 12 days (range, 2-52 days). One hundred eighteen patients (83%) received invasive mechanical ventilation and 19 patients were treated with noninvasive ventilation; however, seven of the patients receiving noninvasive ventilation later needed mechanical ventilation. Sixty-eight patients died (47%) with the most frequent cause refractory hypoxemia. Multivariate logistic regression analysis showed that age <24 months (odds ratio, 2.87; 2.35-3.93), asthma (odds ratio, 1.34; 1.20-2.91), and respiratory coinfection with respiratory syncytial virus (odds ratio, 2.92; 1.20-4.10) were associated with higher mortality. As expected, mechanical ventilation and treatment with inotropes were also associated with increased mortality.
  
  
  CONCLUSIONS
  The mortality of children admitted to the pediatric intensive care unit with 2009 pH1N1 influenza was high (47%) in our population. Age <24 months, asthma, respiratory coinfection, need of mechanical ventilation, and treatment with inotropes were predictors of poorer outcome.
authors.affiliation: Hospital Universitario Austral, Argentina. storres@cas.austral.edu.ar
authors.forename: Silvio Fabio
authors.initials: SF
authors.lastname: Torres
authors.forename: Thomas
authors.initials: T
authors.lastname: Iolster
authors.forename: Eduardo Julio
authors.initials: EJ
authors.lastname: Schnitzler
authors.forename: Julio Alberto
authors.initials: JA
authors.lastname: Farias
authors.forename: Adriana Claudia
authors.initials: AC
authors.lastname: Bordogna
authors.forename: Daniel
authors.initials: D
authors.lastname: Rufach
authors.forename: María José
authors.initials: MJ
authors.lastname: Montes
authors.forename: Alejandro Javier
authors.initials: AJ
authors.lastname: Siaba
authors.forename: María Gabriela
authors.initials: MG
authors.lastname: Rodríguez
authors.forename: Roberto
authors.initials: R
authors.lastname: Jabornisky
authors.forename: Carmen
authors.initials: C
authors.lastname: Colman
authors.forename: Analia
authors.initials: A
authors.lastname: Fernández
authors.forename: Gustavo
authors.initials: G
authors.lastname: Caprotta
authors.forename: Silvia
authors.initials: S
authors.lastname: Diaz
authors.forename: Roxana
authors.initials: R
authors.lastname: Poterala
authors.forename: Marcela
authors.initials: M
authors.lastname: De Meyer
authors.forename: Matías Enrique
authors.initials: ME
authors.lastname: Penazzi
authors.forename: Gustavo
authors.initials: G
authors.lastname: González
authors.forename: Silvia
authors.initials: S
authors.lastname: Saenz
authors.forename: Oscar
authors.initials: O
authors.lastname: Recupero
authors.forename: Luis
authors.initials: L
authors.lastname: Zapico
authors.forename: Blanca
authors.initials: B
authors.lastname: Alarcon
authors.forename: Esen
authors.initials: E
authors.lastname: Ariel
authors.forename: Pablo
authors.initials: P
authors.lastname: Minces
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mari
authors.forename: Antonio
authors.initials: A
authors.lastname: Carnie
authors.forename: Mónica
authors.initials: M
authors.lastname: Garea
authors.forename: Roxana
authors.initials: R
authors.lastname: Jaen
mesh_terms: D001118:Argentina / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000401:mortality* / Q000628:therapy; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D015233:Models, Statistical; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome