title: Efficacy of intravenous immunoglobulin treatment in immunocompromised children with H1N1 influenza: a clinical observation.
abstract: OBJECTIVE
  The appropriate treatment of pandemic H1N1 influenza which was first identified in April 2009 in Mexico is insufficient especially for immunocompromised patients. We aimed to evaluate the features and prognostic factors of the children with H1N1, especially immunocompromised ones, and whether intravenous immunoglobulin G (IVIG) replacement could aid for a better outcome.
  
  
  METHODS
  Twenty-one hospitalized children with laboratory-confirmed H1N1 were evaluated retrospectively. Data were extracted from files and electronic medical records.
  
  
  RESULTS
  The median age was 37 (1-216) months; 62% of them were under 5 years of age and 71.4% had one or more underlying disorders. Main symptoms were high fever, cough, fatigue and vomiting. Lower respiratory tract manifestations were seen in 66.6% of children. Mortality rate was 4.7%. The patient who died had the lowest lymphocyte (100/mm(3) ), thrombocyte (21 000/mm(3) ) and highest blood urea nitrogen (87 mg/dL) levels. Fifty-eight percent of evaluated patients had one of the primary immunodeficiency disorders. Surprisingly, none of the six patients with primary immunodeficiency who are on regular IVIG replacement needed intensive care unit and died. Although median durations of cough, fever and hospitalization were lower, they did not change statistically according to get IVIG replacement regularly (P = 0.47, 0.97, 0.09, respectively).
  
  
  CONCLUSIONS
  Our study is important while it is the first one that shows the course of primary immunodeficient children with H1N1 infection who were on regular IVIG replacement. A trial of high-dose IVIG may be a useful adjunctive therapy in severe H1N1 influenza, particularly in the immunocompromised patients.
authors.affiliation: Department of Pediatric Immunology and Allergy, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Bahar
authors.initials: B
authors.lastname: Gokturk
authors.affiliation: Division of Pediatric Pulmonology, Department of Pediatrics, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey.
authors.forename: Sevgi
authors.initials: S
authors.lastname: Pekcan
authors.affiliation: Division of Pediatric Allergy and Immunology, Department of Pediatrics, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey.
authors.forename: Sukru Nail
authors.initials: SN
authors.lastname: Guner
authors.affiliation: Division of Pediatric Allergy and Immunology, Department of Pediatrics, Selcuk University Medical Faculty, Konya, Turkey.
authors.forename: Hasibe
authors.initials: H
authors.lastname: Artac
authors.affiliation: Division of Pediatric Allergy and Immunology, Department of Pediatrics, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey.
authors.forename: Sevgi
authors.initials: S
authors.lastname: Keles
authors.affiliation: Division of Pediatric Allergy and Immunology, Department of Pediatrics, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey.
authors.forename: Mine
authors.initials: M
authors.lastname: Kirac
authors.affiliation: Division of Pediatric Allergy and Immunology, Department of Pediatrics, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Reisli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D008297:Male; D008800:Mexico; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: H1N1 influenza; child; immunodeficiency; intravenous immunoglobulin G