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Severe H1N1-associated acute respiratory failure in immunocompromised children

Lama Elbahlawan1, Aditya H Gaur, Wayne Furman

  • 1Division of Critical Care Medicine, St. Jude Children's Research Hospital, Tennessee 38105-3678, USA. lama.elbahlawan@stjude.org

Pediatric Blood & Cancer
|February 8, 2011
PubMed

Insights

Critically ill children with cancer receiving chemotherapy who developed severe H1N1 influenza and acute respiratory failure (ARF) all survived with aggressive intensive care. Early detection of oseltamivir-resistant H1N1 is crucial for this vulnerable population.

Area of Science:

  • Pediatric Critical Care Medicine
  • Infectious Diseases
  • Pediatric Oncology

Background:

  • Severe pandemic influenza A (H1N1) infection poses a high mortality risk, particularly for children with malignancy.
  • Immunosuppression from chemotherapy or underlying disease increases H1N1-associated acute respiratory failure (ARF) risk in pediatric oncology patients.

Purpose of the Study:

  • To describe the clinical course and outcomes of critically ill pediatric oncology and hematology patients experiencing H1N1-associated ARF.
  • To evaluate the effectiveness of intensive care interventions in this high-risk group.

Main Methods:

  • Retrospective case series of five pediatric oncology/hematology patients admitted to the ICU with H1N1 infection and ARF during the 2009-2010 influenza season.
  • Detailed analysis of clinical course, ventilatory support, medical management, and patient outcomes.

Main Results:

  • All five patients, despite requiring mechanical ventilation and intensive supportive care (including high-frequency oscillatory ventilation and nitric oxide), survived to hospital discharge.
  • Oseltamivir resistance was noted in two patients, necessitating a switch to intravenous zanamivir.
  • Mean mechanical ventilation duration was 24 days and mean ICU stay was 37 days.

Conclusions:

  • Aggressive supportive care is vital for managing H1N1-related ARF in immunocompromised children with cancer.
  • Early identification and management of oseltamivir-resistant H1N1 infections are critical for favorable outcomes in this vulnerable pediatric population.
Abstract

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