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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Critically Ill Children During the 2009–2010 Influenza Pandemic in the United States</title><author><name sortKey="Randolph, Adrienne G" sort="Randolph, Adrienne G" uniqKey="Randolph A" first="Adrienne G." last="Randolph">Adrienne G. Randolph</name><affiliation><nlm:aff id="aff1">Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts;</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Harvard Medical School, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Vaughn, Frances" sort="Vaughn, Frances" uniqKey="Vaughn F" first="Frances" last="Vaughn">Frances Vaughn</name><affiliation><nlm:aff id="aff3">National Disaster Medical System, Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC;</nlm:aff></affiliation></author><author><name sortKey="Sullivan, Ryan" sort="Sullivan, Ryan" uniqKey="Sullivan R" first="Ryan" last="Sullivan">Ryan Sullivan</name><affiliation><nlm:aff id="aff1">Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Rubinson, Lewis" sort="Rubinson, Lewis" uniqKey="Rubinson L" first="Lewis" last="Rubinson">Lewis Rubinson</name><affiliation><nlm:aff id="aff3">National Disaster Medical System, Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC;</nlm:aff></affiliation></author><author><name sortKey="Thompson, B Taylor" sort="Thompson, B Taylor" uniqKey="Thompson B" first="B. Taylor" last="Thompson">B. Taylor Thompson</name><affiliation><nlm:aff id="aff4">ARDSNet Coordinating Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Yoon, Grace" sort="Yoon, Grace" uniqKey="Yoon G" first="Grace" last="Yoon">Grace Yoon</name><affiliation><nlm:aff id="aff1">Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Smoot, Elizabeth" sort="Smoot, Elizabeth" uniqKey="Smoot E" first="Elizabeth" last="Smoot">Elizabeth Smoot</name><affiliation><nlm:aff id="aff4">ARDSNet Coordinating Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Rice, Todd W" sort="Rice, Todd W" uniqKey="Rice T" first="Todd W." last="Rice">Todd W. Rice</name><affiliation><nlm:aff id="aff5">Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt, Tennessee;</nlm:aff></affiliation></author><author><name sortKey="Loftis, Laura L" sort="Loftis, Laura L" uniqKey="Loftis L" first="Laura L." last="Loftis">Laura L. Loftis</name><affiliation><nlm:aff id="aff6">Department of Pediatrics, Texas Children's Hospital, Houston, Texas;</nlm:aff></affiliation></author><author><name sortKey="Helfaer, Mark" sort="Helfaer, Mark" uniqKey="Helfaer M" first="Mark" last="Helfaer">Mark Helfaer</name><affiliation><nlm:aff id="aff7">Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;</nlm:aff></affiliation></author><author><name sortKey="Doctor, Allan" sort="Doctor, Allan" uniqKey="Doctor A" first="Allan" last="Doctor">Allan Doctor</name><affiliation><nlm:aff id="aff8">Department of Pediatrics, St Louis Children's Hospital, St Louis, Missouri;</nlm:aff></affiliation></author><author><name sortKey="Paden, Matthew" sort="Paden, Matthew" uniqKey="Paden M" first="Matthew" last="Paden">Matthew Paden</name><affiliation><nlm:aff id="aff9">Department of Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia;</nlm:aff></affiliation></author><author><name sortKey="Flori, Heidi" sort="Flori, Heidi" uniqKey="Flori H" first="Heidi" last="Flori">Heidi Flori</name><affiliation><nlm:aff id="aff10">Department of Pediatrics, Children's Hospital Oakland, Oakland, California;</nlm:aff></affiliation></author><author><name sortKey="Babbitt, Christopher" sort="Babbitt, Christopher" uniqKey="Babbitt C" first="Christopher" last="Babbitt">Christopher Babbitt</name><affiliation><nlm:aff id="aff11">Department of Pediatrics, Miller Children's Hospital, Long Beach, California;</nlm:aff></affiliation></author><author><name sortKey="Graciano, Ana Lia" sort="Graciano, Ana Lia" uniqKey="Graciano A" first="Ana Lia" last="Graciano">Ana Lia Graciano</name><affiliation><nlm:aff id="aff12">Department of Pediatrics, Children's Hospital of Central California, Madera, California;</nlm:aff></affiliation></author><author><name sortKey="Gedeit, Rainer" sort="Gedeit, Rainer" uniqKey="Gedeit R" first="Rainer" last="Gedeit">Rainer Gedeit</name><affiliation><nlm:aff id="aff13">Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin;</nlm:aff></affiliation></author><author><name sortKey="Sanders, Ronald C" sort="Sanders, Ronald C" uniqKey="Sanders R" first="Ronald C." last="Sanders">Ronald C. Sanders</name><affiliation><nlm:aff id="aff14">Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas;</nlm:aff></affiliation></author><author><name sortKey="Giuliano, John S" sort="Giuliano, John S" uniqKey="Giuliano J" first="John S." last="Giuliano">John S. Giuliano</name><affiliation><nlm:aff id="aff15">Department of Pediatrics, Yale Children's Hospital, New Haven, Connecticut;</nlm:aff></affiliation></author><author><name sortKey="Zimmerman, Jerry" sort="Zimmerman, Jerry" uniqKey="Zimmerman J" first="Jerry" last="Zimmerman">Jerry Zimmerman</name><affiliation><nlm:aff wicri:cut="; and" id="aff16">Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, Washington</nlm:aff></affiliation></author><author><name sortKey="Uyeki, Timothy M" sort="Uyeki, Timothy M" uniqKey="Uyeki T" first="Timothy M." last="Uyeki">Timothy M. Uyeki</name><affiliation><nlm:aff id="aff17">Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22065262</idno><idno type="pmc">3387899</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387899</idno><idno type="RBID">PMC:3387899</idno><idno type="doi">10.1542/peds.2011-0774</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">000763</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000763</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Critically Ill Children During the 2009–2010 Influenza Pandemic in the United States</title><author><name sortKey="Randolph, Adrienne G" sort="Randolph, Adrienne G" uniqKey="Randolph A" first="Adrienne G." last="Randolph">Adrienne G. Randolph</name><affiliation><nlm:aff id="aff1">Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts;</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Harvard Medical School, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Vaughn, Frances" sort="Vaughn, Frances" uniqKey="Vaughn F" first="Frances" last="Vaughn">Frances Vaughn</name><affiliation><nlm:aff id="aff3">National Disaster Medical System, Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC;</nlm:aff></affiliation></author><author><name sortKey="Sullivan, Ryan" sort="Sullivan, Ryan" uniqKey="Sullivan R" first="Ryan" last="Sullivan">Ryan Sullivan</name><affiliation><nlm:aff id="aff1">Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Rubinson, Lewis" sort="Rubinson, Lewis" uniqKey="Rubinson L" first="Lewis" last="Rubinson">Lewis Rubinson</name><affiliation><nlm:aff id="aff3">National Disaster Medical System, Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC;</nlm:aff></affiliation></author><author><name sortKey="Thompson, B Taylor" sort="Thompson, B Taylor" uniqKey="Thompson B" first="B. Taylor" last="Thompson">B. Taylor Thompson</name><affiliation><nlm:aff id="aff4">ARDSNet Coordinating Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Yoon, Grace" sort="Yoon, Grace" uniqKey="Yoon G" first="Grace" last="Yoon">Grace Yoon</name><affiliation><nlm:aff id="aff1">Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Smoot, Elizabeth" sort="Smoot, Elizabeth" uniqKey="Smoot E" first="Elizabeth" last="Smoot">Elizabeth Smoot</name><affiliation><nlm:aff id="aff4">ARDSNet Coordinating Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Rice, Todd W" sort="Rice, Todd W" uniqKey="Rice T" first="Todd W." last="Rice">Todd W. Rice</name><affiliation><nlm:aff id="aff5">Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt, Tennessee;</nlm:aff></affiliation></author><author><name sortKey="Loftis, Laura L" sort="Loftis, Laura L" uniqKey="Loftis L" first="Laura L." last="Loftis">Laura L. Loftis</name><affiliation><nlm:aff id="aff6">Department of Pediatrics, Texas Children's Hospital, Houston, Texas;</nlm:aff></affiliation></author><author><name sortKey="Helfaer, Mark" sort="Helfaer, Mark" uniqKey="Helfaer M" first="Mark" last="Helfaer">Mark Helfaer</name><affiliation><nlm:aff id="aff7">Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;</nlm:aff></affiliation></author><author><name sortKey="Doctor, Allan" sort="Doctor, Allan" uniqKey="Doctor A" first="Allan" last="Doctor">Allan Doctor</name><affiliation><nlm:aff id="aff8">Department of Pediatrics, St Louis Children's Hospital, St Louis, Missouri;</nlm:aff></affiliation></author><author><name sortKey="Paden, Matthew" sort="Paden, Matthew" uniqKey="Paden M" first="Matthew" last="Paden">Matthew Paden</name><affiliation><nlm:aff id="aff9">Department of Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia;</nlm:aff></affiliation></author><author><name sortKey="Flori, Heidi" sort="Flori, Heidi" uniqKey="Flori H" first="Heidi" last="Flori">Heidi Flori</name><affiliation><nlm:aff id="aff10">Department of Pediatrics, Children's Hospital Oakland, Oakland, California;</nlm:aff></affiliation></author><author><name sortKey="Babbitt, Christopher" sort="Babbitt, Christopher" uniqKey="Babbitt C" first="Christopher" last="Babbitt">Christopher Babbitt</name><affiliation><nlm:aff id="aff11">Department of Pediatrics, Miller Children's Hospital, Long Beach, California;</nlm:aff></affiliation></author><author><name sortKey="Graciano, Ana Lia" sort="Graciano, Ana Lia" uniqKey="Graciano A" first="Ana Lia" last="Graciano">Ana Lia Graciano</name><affiliation><nlm:aff id="aff12">Department of Pediatrics, Children's Hospital of Central California, Madera, California;</nlm:aff></affiliation></author><author><name sortKey="Gedeit, Rainer" sort="Gedeit, Rainer" uniqKey="Gedeit R" first="Rainer" last="Gedeit">Rainer Gedeit</name><affiliation><nlm:aff id="aff13">Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin;</nlm:aff></affiliation></author><author><name sortKey="Sanders, Ronald C" sort="Sanders, Ronald C" uniqKey="Sanders R" first="Ronald C." last="Sanders">Ronald C. Sanders</name><affiliation><nlm:aff id="aff14">Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas;</nlm:aff></affiliation></author><author><name sortKey="Giuliano, John S" sort="Giuliano, John S" uniqKey="Giuliano J" first="John S." last="Giuliano">John S. Giuliano</name><affiliation><nlm:aff id="aff15">Department of Pediatrics, Yale Children's Hospital, New Haven, Connecticut;</nlm:aff></affiliation></author><author><name sortKey="Zimmerman, Jerry" sort="Zimmerman, Jerry" uniqKey="Zimmerman J" first="Jerry" last="Zimmerman">Jerry Zimmerman</name><affiliation><nlm:aff wicri:cut="; and" id="aff16">Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, Washington</nlm:aff></affiliation></author><author><name sortKey="Uyeki, Timothy M" sort="Uyeki, Timothy M" uniqKey="Uyeki T" first="Timothy M." last="Uyeki">Timothy M. Uyeki</name><affiliation><nlm:aff id="aff17">Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia</nlm:aff></affiliation></author></analytic><series><title level="j">Pediatrics</title><idno type="ISSN">0031-4005</idno><idno type="eISSN">1098-4275</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>BACKGROUND:</title><p>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.</p></sec><sec><title>METHODS:</title><p>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.</p></sec><sec><title>RESULTS:</title><p>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) <italic>Staphylococcus aureus</italic> coinfection of the lung with 48% methicillin-resistant <italic>S aureus</italic> (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]; <italic>P</italic> < .0001) remained a mortality risk factor.</p></sec><sec><title>CONCLUSIONS:</title><p>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.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Pediatrics</journal-id><journal-id journal-id-type="iso-abbrev">Pediatrics</journal-id><journal-id journal-id-type="hwp">pediatrics</journal-id><journal-id journal-id-type="pmc">pediatrics</journal-id><journal-id journal-id-type="publisher-id">Pediatrics</journal-id><journal-title-group><journal-title>Pediatrics</journal-title></journal-title-group><issn pub-type="ppub">0031-4005</issn><issn pub-type="epub">1098-4275</issn><publisher><publisher-name>American Academy of Pediatrics</publisher-name><publisher-loc>Elk Grove Village, IL, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22065262</article-id><article-id pub-id-type="pmc">3387899</article-id><article-id pub-id-type="publisher-id">2011-0774</article-id><article-id pub-id-type="doi">10.1542/peds.2011-0774</article-id><article-categories><subj-group subj-group-type="hwp-journal-coll"><subject>3</subject></subj-group><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Critically Ill Children During the 2009–2010 Influenza Pandemic in the United States</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Randolph</surname><given-names>Adrienne G.</given-names></name><degrees>MD, MSc</degrees><xref ref-type="aff" rid="aff1"><sup>a</sup></xref><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Vaughn</surname><given-names>Frances</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sullivan</surname><given-names>Ryan</given-names></name><degrees>RN</degrees><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rubinson</surname><given-names>Lewis</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Thompson</surname><given-names>B. Taylor</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff4"><sup>d</sup></xref></contrib><contrib contrib-type="author"><name><surname>Yoon</surname><given-names>Grace</given-names></name><degrees>RN, NNP</degrees><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Smoot</surname><given-names>Elizabeth</given-names></name><degrees>MS</degrees><xref ref-type="aff" rid="aff4"><sup>d</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rice</surname><given-names>Todd W.</given-names></name><degrees>MD, MSc</degrees><xref ref-type="aff" rid="aff5"><sup>e</sup></xref></contrib><contrib contrib-type="author"><name><surname>Loftis</surname><given-names>Laura L.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff6"><sup>f</sup></xref></contrib><contrib contrib-type="author"><name><surname>Helfaer</surname><given-names>Mark</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff7"><sup>g</sup></xref></contrib><contrib contrib-type="author"><name><surname>Doctor</surname><given-names>Allan</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff8"><sup>h</sup></xref></contrib><contrib contrib-type="author"><name><surname>Paden</surname><given-names>Matthew</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff9"><sup>i</sup></xref></contrib><contrib contrib-type="author"><name><surname>Flori</surname><given-names>Heidi</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff10"><sup>j</sup></xref></contrib><contrib contrib-type="author"><name><surname>Babbitt</surname><given-names>Christopher</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff11"><sup>k</sup></xref></contrib><contrib contrib-type="author"><name><surname>Graciano</surname><given-names>Ana Lia</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff12"><sup>l</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gedeit</surname><given-names>Rainer</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff13"><sup>m</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sanders</surname><given-names>Ronald C.</given-names></name><degrees>MD, MS</degrees><xref ref-type="aff" rid="aff14"><sup>n</sup></xref></contrib><contrib contrib-type="author"><name><surname>Giuliano</surname><given-names>John S.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff15"><sup>o</sup></xref></contrib><contrib contrib-type="author"><name><surname>Zimmerman</surname><given-names>Jerry</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff16"><sup>p</sup></xref></contrib><contrib contrib-type="author"><name><surname>Uyeki</surname><given-names>Timothy M.</given-names></name><degrees>MD, MPH, MPP</degrees><xref ref-type="aff" rid="aff17"><sup>q</sup></xref></contrib><contrib contrib-type="author"><collab>for the Pediatric Acute Lung Injury and Sepsis Investigator's Network and the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network</collab></contrib><aff id="aff1"><label>a</label>Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts;</aff><aff id="aff2"><label>b</label>Harvard Medical School, Boston, Massachusetts;</aff><aff id="aff3"><label>c</label>National Disaster Medical System, Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC;</aff><aff id="aff4"><label>d</label>ARDSNet Coordinating Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;</aff><aff id="aff5"><label>e</label>Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt, Tennessee;</aff><aff id="aff6"><label>f</label>Department of Pediatrics, Texas Children's Hospital, Houston, Texas;</aff><aff id="aff7"><label>g</label>Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;</aff><aff id="aff8"><label>h</label>Department of Pediatrics, St Louis Children's Hospital, St Louis, Missouri;</aff><aff id="aff9"><label>i</label>Department of Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia;</aff><aff id="aff10"><label>j</label>Department of Pediatrics, Children's Hospital Oakland, Oakland, California;</aff><aff id="aff11"><label>k</label>Department of Pediatrics, Miller Children's Hospital, Long Beach, California;</aff><aff id="aff12"><label>l</label>Department of Pediatrics, Children's Hospital of Central California, Madera, California;</aff><aff id="aff13"><label>m</label>Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin;</aff><aff id="aff14"><label>n</label>Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas;</aff><aff id="aff15"><label>o</label>Department of Pediatrics, Yale Children's Hospital, New Haven, Connecticut;</aff><aff id="aff16"><label>p</label>Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, Washington; and</aff><aff id="aff17"><label>q</label>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia</aff></contrib-group><author-notes><corresp>Address correspondence to Adrienne G. Randolph, MD, MSc, Children's Hospital Boston, 300 Longwood Ave, Bader 634, Boston, MA 02115. E-mail: <email>adrienne.randolph@childrens.harvard.edu</email></corresp></author-notes><pub-date pub-type="ppub"><month>12</month><year>2011</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>12</month><year>2012</year></pub-date><pmc-comment> PMC Release delay is 12 months and 0 days and was based on the
<volume>128</volume><issue>6</issue><fpage>e1450</fpage><lpage>e1458</lpage><history><date date-type="accepted"><day>31</day><month>8</month><year>2011</year></date></history><permissions><copyright-statement>Copyright © 2011 by the American Academy of Pediatrics</copyright-statement><copyright-year>2011</copyright-year></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="zpe012110e1450.pdf"></self-uri><abstract><sec><title>BACKGROUND:</title><p>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.</p></sec><sec><title>METHODS:</title><p>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.</p></sec><sec><title>RESULTS:</title><p>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) <italic>Staphylococcus aureus</italic> coinfection of the lung with 48% methicillin-resistant <italic>S aureus</italic> (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]; <italic>P</italic> < .0001) remained a mortality risk factor.</p></sec><sec><title>CONCLUSIONS:</title><p>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.</p></sec></abstract><kwd-group><kwd>influenza</kwd><kwd>intensive care unit</kwd><kwd>pediatric</kwd><kwd>mortality</kwd><kwd>pandemic</kwd><kwd>MRSA</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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