title: 2009 pandemic influenza A (H1N1) in critically ill children in Cincinnati, Ohio.
abstract: OBJECTIVE
  To compare the clinical features, management, and outcome of critically ill children with H1N1 to children with seasonal influenza from the previous three influenza seasons.
  
  
  METHODS
  The overall number of hospitalizations and the proportion cared for in the pediatric intensive care unit during the H1N1 epidemic period and the three previous influenza seasons (2007-2009) were determined. Medical records of patients admitted to the pediatric intensive care unit with H1N1 and seasonal influenza infection were reviewed.
  
  
  METHODS
  Cincinnati Children's Hospital Medical Center, a large, 523-bed hospital located in Cincinnati.
  
  
  METHODS
  Hospitalized children with laboratory-confirmed seasonal or H1N1 infection.
  
  
  METHODS
  Study variables included demographic data (age, gender), clinical factors (weight, Pediatric Risk of Mortality III scores, presenting signs and symptoms, comorbid conditions), management (length of mechanical ventilation, other treatments, including high-frequency oscillatory ventilatory support, inhaled nitric oxide, or extracorporeal membrane oxygenation), and outcome (overall and pediatric intensive care unit length of stay and mortality).
  
  
  RESULTS
  Overall, 312 children were hospitalized with H1N1 and 222 with seasonal influenza from the three previous seasons. Children with H1N1 infection were significantly less likely to require pediatric intensive care unit care compared to children with seasonal influenza infection (14% vs. 24%, p = .02). Compared to children with seasonal influenza, children in the pediatric intensive care unit with H1N1 were older (median age in months 107 vs. 68, p = .05) and significantly more likely to have comorbid conditions (64% vs. 40%, p = .03), especially respiratory conditions. While there were no significant differences in severity of illness by Pediatric Risk of Mortality III scores or pediatric intensive care unit length of stay, children with H1N1 were significantly less likely to have acute respiratory failure (p = .04) or die compared to children with seasonal influenza infection (p = .03).
  
  
  CONCLUSIONS
  In contrast to other studies, we found that critically ill children with H1N1 had a significantly lower morbidity and mortality compared to children with seasonal influenza.
authors.affiliation: Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Carrie I
authors.initials: CI
authors.lastname: Morgan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hobson
authors.forename: Brandy
authors.initials: B
authors.lastname: Seger
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Rice
authors.forename: Mary A
authors.initials: MA
authors.lastname: Staat
authors.forename: Derek S
authors.initials: DS
authors.lastname: Wheeler
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D016638:Critical Illness; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D015278:Intensive Care Units, Pediatric; D008297:Male; D009820:Ohio; D053139:Oseltamivir / Q000627:therapeutic use; D058873:Pandemics; D012138:Respiratory Therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir