Children's Hospital Boston, Boston, MA 02115, USA.
Pediatrics. 2011 Dec;128(6):e1450-8. doi: 10.1542/peds.2011-0774. Epub 2011 Nov 7.
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.
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.
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.
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.
2009 年甲型 H1N1 流感（pH1N1）病毒仍在全球范围内传播。由于与 pH1N1 相关的危重症患儿的数据有限，确定慢性疾病和细菌合并感染在死亡率中的作用具有挑战性。
我们确定了 2009 年 4 月 15 日至 2010 年 4 月 15 日期间在美国 35 个 PICUs 中确诊或疑似 pH1N1 感染的儿童（年龄<21 岁）。我们收集了人口统计学、基线健康状况、实验室结果、治疗和结果的数据。
在 pH1N1 感染收入 PICUs 的 838 名儿童中，中位年龄为 6 岁，58%为男性，70%有≥1 种慢性健康状况，88.2%接受了奥司他韦（5.8%在收入 PICUs 前开始）。大多数患者有呼吸衰竭，564 例（67.3%）接受机械通气；162 例（19.3%）接受升压治疗，75 例（8.9%）死亡。总体而言，71 例（8.5%）患儿疑似早期（收入 PICUs 后 72 小时内）金黄色葡萄球菌肺部合并感染，其中 48%为耐甲氧西林金黄色葡萄球菌（MRSA）。多变量分析显示，存在神经发育障碍或免疫抑制、脑炎（占病例的 1.7%）、心肌炎（占病例的 1.4%）、早期疑似 MRSA 肺部合并感染以及女性为死亡风险因素。在 251 名既往健康的儿童中，只有早期疑似 MRSA 肺部合并感染（相对风险：8 [95%置信区间：3.1-20.6]；P<.0001）仍然是死亡的风险因素。
收入 PICUs 后，存在神经发育障碍和免疫抑制的患儿 pH1N1 相关死亡风险增加。pH1N1 的继发性并发症，包括心肌炎、脑炎和临床诊断的早期疑似 MRSA 肺部合并感染，是死亡的风险因素。
