1238 Critically Ill Children with Pandemic Influenza (H1N1) 2009 in Pediatric Intensive Care Units in Turkey

Abstract

Objective: To demonstrate the epidemiological features, clinical presentation, clinical courses and outcomes in critically ill children with pandemic influenza (H1N1) 2009 in pediatric intensive care units (PICU).Design and setting: Prospective, observational, multi-center study and 13 tertiary PICUs.Patients: 83 children with confirmed infection due to pandemic influenza (H1N1) 2009, detected by RT-PCR between November 1 and December 31, 2009 who required PICU.Results: In two months period, 532 children were hospitalized with pandemic influenza (H1N1) 2009 and 83 (15.6%) of them needed critical care. For the 83 patients requiring critical care, the median age was 42 months. Twenty of these patients (24.1%) had no underlying illness. The PICU admission indications were respiratory distress/respiratory failure in 66 (79.5%), neurologic deterioration in 6 (7.2%) and gastrointestinal symptoms in 5 (6.0%) of the patients. Acute lung injury was diagnosed in 23 (27.7%), acute respiratory distress syndrome in 34 (41%) of the critically ill children and 51 (61.4%) patients needed mechanical ventilation (MV). Oseltamivir was used in 80 (96%) patients. During the study period, overall mortality rate was 13.7%, however, mortality rate was 30.1% (n=25) in children with pandemic influenza A (H1N1) 2009 (p=0.0016) in PICUs. Cause of death was primary H1N1 infection in 16 (64%), nosocomial infection in 4 (16%) and primary disease progression in 5 (20%) patients.Conclusion: Severe disease and high mortality were seen in children with pandemic influenza (H1N1) 2009. Death occurred in all age groups of children with or without underlying illness.