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Critical Illness From H1N1 Virus in Children Unpredictable, But Survivable BETHESDA, Md -- January 7, 2010 -- Lessons learned from the first 13 children at Johns Hopkins Children’s Center, Baltimore, Maryland, to become critically ill from the influenza A(H1N1) virus show that although all patients survived, serious complications developed quickly, unpredictably, with great variations from patient to patient and with serious need for vigilant monitoring and quick treatment adjustments. The analysis, published online in the journal Pediatric Critical Care Medicine, showed that 12 out of the 13 very ill children had underlying medical conditions that made them more vulnerable, including sickle cell disease, asthma, and HIV. Complications varied from temporary kidney failure to acute respiratory distress syndrome, dangerously low oxygen levels, and dangerously low blood pressure. An important finding was that rapid screening tests were initially negative in 8 out of the 13 children, underscoring the need for more sensitive tests. Therefore, the researchers said, all critically ill children with flu-like symptoms regardless of test results should be treated preemptively with antiviral medications. “Our most surprising, and perhaps most important finding, is that the H1N1 virus behaves unpredictably and variably from one patient to the other and even within the same patient from day to day, so we must be on our toes and react fast by adjusting therapy,” says lead investigator Justin Lockman, Pediatric Critical Care, at Johns Hopkins Children’s Center. Investigators caution that more and larger studies are needed to guide future practice and recommendations for H1N1 treatment in children. “Our analysis did reveal some interesting patterns and trends, but it also showed us how much more we have to learn about the behaviour of this new and intriguing virus,” said senior investigator David Nichols, MD, at the Johns Hopkins School of Medicine. The Hopkins team analysed data from 140 peadiatric patients diagnosed with H1N1 between June 2009 and August 2009, of whom 13 went on to develop critical illness and were admitted to the paediatric intensive care unit (PICU) at Hopkins Children’s. Other findings reported in the article include: · Asthma was the most common underlying chronic condition (11 of the 13 children had it), followed by neuromuscular diseases like cerebral palsy. · Nearly half of the children became so sick they needed a ventilator to help them breathe. However, no children died or required extra-corporeal membrane oxygenation. · One-fourth of the children developed dangerous secondary bacterial infections, more often than previously believed, which points to the need for watchful monitoring for such infections in children with H1N1. SOURCE: Johns Hopkins Medical Instiitutions E-mail this page to a friend or colleague! To print, use this version