2009 年冬季澳大利亚和新西兰需要重症监护的儿童中的大流行性 H1N1。

Pandemic H1N1 in children requiring intensive care in Australia and New Zealand during winter 2009.

机构信息

Intensive Care Unit, Women's and Children's Hospital, Adelaide, Australia.

出版信息

Pediatrics. 2011 Jan;127(1):e156-63. doi: 10.1542/peds.2010-0801. Epub 2010 Dec 20.

DOI:10.1542/peds.2010-0801

PMID:21172991

Abstract

OBJECTIVE

To describe in detail the pediatric intensive care experience of influenza A, particularly pandemic H1N1-09, in Australia and New Zealand during the 2009 Southern Hemisphere winter and to compare the pediatric experience with that of adults.

METHOD

This was an inception-cohort study of all children who were admitted to intensive care with confirmed influenza A during winter 2009 at all general ICUs and PICUs in Australia and New Zealand.

RESULTS

From June 1 through August 31, 2009, 107 children (20.0 per million [95% confidence interval: 16.1-23.8]) with influenza A, including 83 (15.5 per million [95% confidence interval: 12.1-18.9]) with H1N1-09 were admitted to ICUs. Fifty-two percent (39 of 75) of children with H1N1-09 had 1 or more comorbidity, most commonly neurologic (20%). Most (48 of 83 [58%]) presented with pneumonia. Thirteen of 83 (16%) had neurologic presentations. Eighty percent of the children with H1N1-09 required ventilation. Mortality was lower than in adults: 6 of 83 (7%) vs 114 of 668 (17%) (P = .02). The median length of stay for children with H1N1-09 was 5 days. Children with H1N1-09 occupied 773 bed-days (147 per million children) and 5.8% of specialist PICU beds. Presentation with septic shock or after cardiac arrest and the presence of 1 or more comorbidities were risk factors for severe disease.

CONCLUSIONS

H1N1-09 caused a substantial burden on pediatric intensive care services in Australia and New Zealand. Compared with adults, children more commonly had nonrespiratory presentations and required ventilation more often but had a lower mortality rate.

摘要

目的

详细描述澳大利亚和新西兰 2009 年南半球冬季甲型流感（尤其是 H1N1-09 大流行株）在儿科重症监护病房的发病情况，并将儿科患者的发病情况与成人进行比较。

方法

这是一项在澳大利亚和新西兰所有普通 ICU 和儿科 ICU 进行的甲型流感确诊患儿的病例系列研究。

结果

2009 年 6 月 1 日至 8 月 31 日，共有 107 例甲型流感患儿（每百万 20.0 例[95%置信区间：16.1-23.8]），包括 83 例 H1N1-09 患儿（每百万 15.5 例[95%置信区间：12.1-18.9]）收入 ICU。83 例 H1N1-09 患儿中，52%（39 例）存在 1 种或多种合并症，最常见的是神经系统疾病（20%）。大多数（48/83[58%]）患儿表现为肺炎，13 例（16%）有神经系统表现。83 例患儿中，80%需要通气治疗。H1N1-09 患儿死亡率低于成人：6/83（7%）比 668/83（17%）（P=0.02）。H1N1-09 患儿的中位住院时间为 5 天。H1N1-09 患儿占用 773 张床位（每百万儿童 147 张）和 5.8%的专科儿科 ICU 床位。出现感染性休克或心脏骤停后入院以及存在 1 种或多种合并症是病情严重的危险因素。