High mortality in patients with influenza A pH1N1 2009 admitted to a pediatric intensive care unit
Male
Models, Statistical
Argentina
Infant
Intensive Care Units, Pediatric
Respiration, Artificial
3. Good health
03 medical and health sciences
Influenza A Virus, H1N1 Subtype
Treatment Outcome
0302 clinical medicine
Risk Factors
Child, Preschool
Influenza, Human
Humans
Female
Hospital Mortality
Retrospective Studies
DOI:
10.1097/pcc.0b013e318219266b
Publication Date:
2011-05-06T08:43:47Z
AUTHORS (28)
ABSTRACT
To describe the clinical characteristics and outcome of patients admitted to pediatric intensive care with influenza A (pH1N1) 2009 in Argentina.Retrospective observational study.Thirteen pediatric intensive care units in Argentina.One hundred and forty-two patients with confirmed or suspected influenza A (H1N1).None.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.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.
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