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Published on: December 4, 2015
2009 pandemic influenza A (H1N1) in critically ill children in Cincinnati, Ohio
Carrie I Morgan1, Michael J Hobson, Brandy Seger
1Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Insights
Critically ill children with H1N1 influenza had lower morbidity and mortality than those with seasonal influenza. This study found reduced intensive care unit admissions and fewer deaths in H1N1 cases.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Influenza A (H1N1) emerged as a novel strain, necessitating comparison with seasonal influenza in pediatric populations.
- Understanding H1N1's impact on critically ill children is crucial for public health preparedness.
Purpose of the Study:
- To compare clinical features, management, and outcomes of critically ill children infected with H1N1 versus seasonal influenza.
- To identify differences in pediatric intensive care unit (PICU) utilization and mortality rates between H1N1 and seasonal influenza.
Main Methods:
- Retrospective review of medical records for hospitalized children with confirmed H1N1 or seasonal influenza.
- Data collected included demographics, clinical factors, management strategies, and outcomes (PICU stay, mortality).
- Comparison between H1N1 and seasonal influenza groups at Cincinnati Children's Hospital Medical Center.
Main Results:
- Children with H1N1 were less likely to require PICU care (14% vs. 24%).
- H1N1 patients in the PICU were older and had more comorbid conditions, particularly respiratory issues.
- H1N1 cases showed significantly lower rates of acute respiratory failure and mortality compared to seasonal influenza.
Conclusions:
- Critically ill children with H1N1 experienced significantly lower morbidity and mortality than those with seasonal influenza.
- Findings contrast with some previous studies, highlighting a potentially less severe clinical course for H1N1 in this pediatric cohort.
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.
Design:
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.
Setting:
Cincinnati Children's Hospital Medical Center, a large, 523-bed hospital located in Cincinnati.
Patients:
Hospitalized children with laboratory-confirmed seasonal or H1N1 infection.
Measurements:
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).
Main 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.
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