Critically ill children during the 2009-2010 influenza pandemic in the United States
| Autor: | Adrienne G, Randolph, Frances, Vaughn, Ryan, Sullivan, Lewis, Rubinson, B Taylor, Thompson, Grace, Yoon, Elizabeth, Smoot, Todd W, Rice, Laura L, Loftis, Mark, Helfaer, Allan, Doctor, Matthew, Paden, Heidi, Flori, Christopher, Babbitt, Ana Lia, Graciano, Rainer, Gedeit, Ronald C, Sanders, John S, Giuliano, Jerry, Zimmerman, Timothy M, Uyeki, Kate, Luther |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Oseltamivir Adolescent Critical Illness medicine.disease_cause law.invention chemistry.chemical_compound Young Adult Influenza A Virus H1N1 Subtype law Influenza Human medicine Humans Child Pandemics Retrospective Studies Pediatric intensive care unit business.industry Infant Retrospective cohort study Articles medicine.disease Intensive care unit Methicillin-resistant Staphylococcus aureus United States Respiratory failure chemistry Relative risk Child Preschool Pediatrics Perinatology and Child Health Coinfection Female business |
| Zdroj: | Pediatrics. 128(6) |
| ISSN: | 1098-4275 |
| Popis: | BACKGROUND: The 2009 pandemic influenza A (H1N1) (pH1N1) virus continues to circulate worldwide. Determining the roles of chronic conditions and bacterial coinfection in mortality is difficult because of the limited data for children with pH1N1-related critical illness. METHODS: We identified children ( RESULTS: Of 838 children with pH1N1 admitted to a PICU, the median age was 6 years, 58% were male, 70% had ≥1 chronic health condition, and 88.2% received oseltamivir (5.8% started before PICU admission). Most patients had respiratory failure with 564 (67.3%) receiving mechanical ventilation; 162 (19.3%) received vasopressors, and 75 (8.9%) died. Overall, 71 (8.5%) of the patients had a presumed diagnosis of early (within 72 hours after PICU admission) Staphylococcus aureus coinfection of the lung with 48% methicillin-resistant S aureus (MRSA). In multivariable analyses, preexisting neurologic conditions or immunosuppression, encephalitis (1.7% of cases), myocarditis (1.4% of cases), early presumed MRSA lung coinfection, and female gender were mortality risk factors. Among 251 previously healthy children, only early presumed MRSA coinfection of the lung (relative risk: 8 [95% confidence interval: 3.1–20.6]; P < .0001) remained a mortality risk factor. CONCLUSIONS: Children with preexisting neurologic conditions and immune compromise were at increased risk of pH1N1-associated death after PICU admission. Secondary complications of pH1N1, including myocarditis, encephalitis, and clinical diagnosis of early presumed MRSA coinfection of the lung, were mortality risk factors. |
| Databáze: | OpenAIRE |
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