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Predictors of severe H1N1 infection in children presenting within Pediatric Emergency Research Networks (PERN):
Stuart R Dalziel1, John Md Thompson, Charles G Macias
1Starship Children's Hospital, Auckland, New Zealand.
Insights
Identifying risk factors for severe H1N1 outcomes in children is crucial for pandemic preparedness. Key indicators include chronic lung disease, chest retractions, and dehydration, which may alert clinicians to at-risk pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Epidemiology
Background:
- Influenza A (H1N1) outbreaks can lead to severe outcomes in children.
- Early identification of risk factors is essential for timely intervention during influenza pandemics.
Purpose of the Study:
- To identify historical and clinical findings associated with severe H1N1 outcomes in pediatric patients presenting with influenza-like illness (ILI).
Main Methods:
- Multicenter retrospective case-control study involving 265 children with confirmed H1N1 and ILI.
- Compared children with severe outcomes (death, ICU admission) to controls without severe outcomes.
- Utilized multivariable conditional logistic regression to determine adjusted odds ratios for risk factors.
Main Results:
- Six factors independently associated with severe H1N1 outcomes were identified.
- These include history of chronic lung disease, cerebral palsy/developmental delay, chest retractions, dehydration, oxygen requirement, and tachycardia.
- 10% of the pediatric cases included in the study died.
Conclusions:
- Specific clinical and historical findings can alert clinicians to children at high risk for severe H1N1 outcomes.
- These identified risk factors are valuable for managing pediatric influenza-like illness during future pandemics.
Objective:
To identify historical and clinical findings at emergency department presentation associated with severe H1N1 outcome in children presenting with influenza-like illness.
Design:
Multicentre retrospective case-control study.
Setting:
79 emergency departments of hospitals associated with the Pediatric Emergency Research Networks in 12 countries.
Participants:
265 children (<16 years), presenting between 16 April and 31 December 2009, who fulfilled Centers for Disease Control and Prevention criteria for influenza-like illness and developed severe outcomes from laboratory confirmed H1N1 infection. For each case, two controls presenting with influenza-like illness but without severe outcomes were included: one random control and one age matched control.
Main Outcome Measures:
Severe outcomes included death or admission to intensive care for assisted ventilation, inotropic support, or both. Multivariable conditional logistic regression was used to compare cases and controls, with effect sizes measured as adjusted odds ratios.
Results:
151 (57%) of the 265 cases were male, the median age was 6 (interquartile range 2.3-10.0) years, and 27 (10%) died. Six factors were associated with severe outcomes in children presenting with influenza-like illness: history of chronic lung disease (odds ratio 10.3, 95% confidence interval 1.5 to 69.8), history of cerebral palsy/developmental delay (10.2, 2.0 to 51.4), signs of chest retractions (9.6, 3.2 to 29.0), signs of dehydration (8.8, 1.6 to 49.3), requirement for oxygen (5.8, 2.0 to 16.2), and tachycardia relative to age).
Conclusion:
These independent risk factors may alert clinicians to children at risk of severe outcomes when presenting with influenza-like illness during future pandemics.
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