Predictors of Mortality in Hospitalized Children with Pandemic H1N1 Influenza 2009 in Pune, India

被引:14
作者
Kinikar, Aarti Avinash [1 ,2 ]
Kulkarni, Rajesh K. [1 ,2 ]
Valvi, Chhaya T. [1 ,2 ]
Mave, Vidya [5 ]
Gupte, Nikhil [5 ]
Khadse, Sandhya [1 ,2 ]
Bhardwaj, Renu [2 ,3 ]
Kagal, Anju [2 ,3 ]
Puranik, Shaila [2 ,4 ]
Gupta, Amita [6 ]
Bollinger, Robert [6 ]
Jamkar, Arun [2 ]
机构
[1] BJ Med Coll, Dept Pediat, Pune, Maharashtra, India
[2] Sassoon Gen Hosp, Pune, Maharashtra, India
[3] BJ Med Coll, Dept Microbiol, Pune, Maharashtra, India
[4] BJ Med Coll, Dept Pathol, Pune, Maharashtra, India
[5] BJ Med Coll, Clin Trials Unit, Pune, Maharashtra, India
[6] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA
关键词
Pandemic; 2009; H1N1; virus; Mortality; Children; CRITICALLY-ILL PATIENTS; A H1N1; A(H1N1);
D O I
10.1007/s12098-011-0578-7
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
To analyse the factors associated with increased mortality among Indian Children with H1N1. Data were abstracted from available hospital records of children less than 12 y of age, who were admitted to Sassoon General Hospital in Pune, India, with confirmed pandemic 2009 H1N1 influenza infection from August 2009 through January 2010. Logistic regression analysis was used to identify clinical characteristics associated with mortality. Of 775 pediatric cases admitted with Influenza Like Illness (ILI), 92 (11.8%) had confirmed H1N1 influenza infection. The median age of HIN1 cases was 2.5 y; 13 (14%) had an associated co-morbid condition. Median duration of symptoms was 4 d (interquartile range (IQR), 3-7 d). All 92 H1N1 cases received oseltamivir and empiric antimicrobials on admission. Intensive care unit (ICU) admission was required for 88 (96%) children, and 20 (23%) required mechanical ventilation.Fifteen children (16%) died; mortality was associated with presence of diffuse alveolar infiltrate on admission chest radiography (odds ratio (OR) 45, 95%CI :5.4-370; p < 0.001), use of corticosteroids in ARDS in children who required mechanical ventilation (OR 8.12, 95%CI: 2.44-27.05; p = 0.001), SpO(2) < 80% on admission (OR 32.8, 95% CI: 5.8-185.5; p < 0.001) and presence of ARDS (OR 345.3, 95% CI :33.5-3564.1; p < 0.001). Necropsy from all children who died showed 9 (60%) had ARDS pattern and necrotizing pneumonitis, diffuse hemorrhage and interstitial pneumonia (n = 4 each, 27%) with gram positive organisms consistent with severe viral and bacterial co-infection. Hypoxia, ARDS and use of corticosteroids in children with ARDS who were mechanically ventilated were the factors associated with increased odds of mortality. Necropsy also suggested bacterial co-infection as a risk factor.
引用
收藏
页码:459 / 466
页数:8
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