Cited by 222Influenza Virus Research StudiesRespiratory viral infections researchInfectious Encephalopathies and Encephalitis

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Critically Ill Children During the 2009–2010 Influenza Pandemic in the United States

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Randolph, Adrienne G., Vaughn, Frances, Sullivan, Ryan, Rubinson, Lewis, Thompson, B. Taylor, Yoon, Grace, Smoot, Elizabeth, Rice, Todd W., Loftis, Laura L., Helfaer, Mark, Doctor, Allan, Paden, Matthew, Flori, Heidi, Babbitt, Christopher, Graciano, Ana Lia, Gedeit, Rainer, Sanders, Ronald C., Giuliano, John S., Zimmerman, Jerry, Uyeki, Timothy M., for the Pediatric Acute Lung Injury and Sepsis Investigator's Network and the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network·2011·Pediatrics

DOI 10.1542/peds.2011-0774PMC PMC3387899

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Abstract

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 (<21 years old) with confirmed or probable pH1N1 admitted to 35 US PICUs from April 15, 2009, through April 15, 2010. We collected data on demographics, baseline health, laboratory results, treatments, and outcomes. 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.

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Authors: Randolph, A. G., Vaughn, F., Sullivan, R., Rubinson, L., Thompson, B. T., Yoon, G., Smoot, E., Rice, T. W., Loftis, L. L., Helfaer, M., Doctor, A., Paden, M., Flori, H., Babbitt, C., Graciano, A. L., Gedeit, R., Sanders, R. C., Giuliano, J. S., Zimmerman, J., Uyeki, T. M., & for the Pediatric Acute Lung Injury and Sepsis Investigator's Network and the National Heart, L.
Affiliations: Boston Children's Hospital (US)
United States Department of Health and Human Services (US)
Harvard University (US)
Vanderbilt University (US)
Baylor College of Medicine (US)
Children's Hospital of Philadelphia (US)
St. Louis Children's Hospital (US)
Henrietta Egleston Hospital for Children (US)
Department of Pediatrics, Children's Hospital Oakland, Oakland, California;
Miller Children's & Women's Hospital (US)
Department of Pediatrics, Children's Hospital of Central California, Madera, California;
Children's Hospital of Wisconsin (US)
Arkansas Children's Hospital (US)
Yale University (US)
Seattle Children's Hospital (US)
Centers for Disease Control and Prevention (US)
ORCID: Randolph, Adrienne G.
Thompson, B. Taylor
Rice, Todd W.
Loftis, Laura L.
Doctor, Allan
Flori, Heidi
Babbitt, Christopher
Gedeit, Rainer
Giuliano, John S.
Zimmerman, Jerry
Uyeki, Timothy M.
Venue: Pediatrics
Publisher: American Academy of Pediatrics (AAP)
Published: 2011-12-01
Volume: 128
Issue: 6
Pages: e1450-e1458
ISSN: 0031-4005 (ISSN-L)
1098-4275
DOI: 10.1542/peds.2011-0774
PMC: PMC3387899
OpenAlex: W2169416010
Cited by: 222
References: 61
Citations by year: 2026: 5 · 2025: 8 · 2024: 2 · 2023: 6 · 2022: 17 · 2021: 6 · 2020: 14 · 2019: 20 · 2018: 21 · 2017: 18 · 2016: 11 · 2015: 22 · 2014: 15 · 2013: 35 · 2012: 21
FWCI: 17.28
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: PEDIATRICS (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: U.S. Department of Health and Human Services
National Institutes of Health (n01hr56179-17-0-1)
National Heart, Lung, and Blood Institute (N01 HR 56179, N01 HR056179)
National Institute of Allergy and Infectious Diseases (R56AI084011)
Topics: Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
Keywords: 2009 H1N1 pandemic, pediatric intensive care, critically ill children, mortality risk factors, methicillin-resistant Staphylococcus aureus, bacterial co-infection, respiratory failure, mechanical ventilation, vasopressors, neurologic conditions, immunosuppression, encephalitis, myocarditis, oseltamivir, chronic disease
MeSH terms: Adolescent, Child, Child, Preschool, Female, Humans, Infant, Influenza, Human, Male, Retrospective Studies, United States, Critical Illness, Influenza A Virus, H1N1 Subtype, Young Adult, Pandemics

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