Intensive Care Medicine

, Volume 36, Issue 6, pp 1015–1022 | Cite as

Critically ill infants and children with influenza A (H1N1) in pediatric intensive care units in Argentina

  • Julio A. FariasEmail author
  • Analía Fernández
  • Ezequiel Monteverde
  • Nilda Vidal
  • Pilar Arias
  • María J. Montes
  • Gabriela Rodríguez
  • Mariela Allasia
  • Maria E. Ratto
  • Roxana Jaén
  • Claudia Meregalli
  • Karina Fiquepron
  • Ana R. Calvo
  • Alejandro Siaba
  • Lidia Albano
  • Rossana Poterala
  • Pablo Neira
  • Andrés Esteban
Pediatric Original



To determine the epidemiological features, course, and outcomes of critically ill pediatric patients with Influenza A (H1N1) virus.


Prospective cohort of children in pediatric intensive care units (PICUs) due to Influenza A (H1N1) virus infection.


Seventeen medical-surgical PICUs in tertiary care hospital in Argentina.


All consecutive patients admitted to the PICUs with influenza A (H1N1) viral infection from 15 June to 31 July 2009.

Measurements and main results

Of 437 patients with acute lower respiratory infection in PICUs, 147 (34%) were diagnosed with influenza A (H1N1) related to critical illness. The median age of these patients was 10 months (IQR 3–59). Invasive mechanical ventilation was used in 117 (84%) on admission. The rate of acute respiratory distress syndrome (ARDS) was 80% (118 of 147 patients). Initial non-invasive ventilation failed in 19 of 22 attempts (86%). Mortality at 28 days was 39% (n = 57). Chronic complex conditions (CCCs), acute renal dysfunction (ARD) and ratio PaO2/FiO2 at day 3 on MV were independently associated with a higher risk of mortality. The odds ratio (OR) for CCCs was 3.06, (CI 95% 1.36–6.84); OR for ARD, 3.38, (CI 95% 1.45–10.33); OR for PaO2/FiO2, 4 (CI 95% 1.57–9.59). The administration of oseltamivir within 24 h after admission had a protective effect: OR 0.2 (CI 95% 0.07–0.54).


In children with ARDS, H1N1 as an etiologic agent confers high mortality, and the presence of CCCs in such patients increases the risk of death.


Critically ill Influenza A (H1N1) Infants and children Mechanical ventilation Survey 



We are grateful to Brian Kavanagh for his comments and suggestions on the manuscript. This study was in part supported by the Sociedad Argentina de Terapia Intensiva (SATI).

Conflict of interest statement

The authors have no conflicts of interest to disclose.


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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Julio A. Farias
    • 1
    Email author
  • Analía Fernández
    • 1
  • Ezequiel Monteverde
    • 1
  • Nilda Vidal
    • 2
  • Pilar Arias
    • 3
  • María J. Montes
    • 4
  • Gabriela Rodríguez
    • 5
  • Mariela Allasia
    • 6
  • Maria E. Ratto
    • 7
  • Roxana Jaén
    • 8
  • Claudia Meregalli
    • 9
  • Karina Fiquepron
    • 10
  • Ana R. Calvo
    • 11
  • Alejandro Siaba
    • 12
  • Lidia Albano
    • 2
  • Rossana Poterala
    • 13
  • Pablo Neira
    • 13
  • Andrés Esteban
    • 14
  1. 1.Unidad de Cuidados Intensivos PediátricosHospital de Niños R GutiérrezBuenos AiresArgentina
  2. 2.Unidad de Cuidados Intensivos PediátricosHospital A PosadasHaedo, Buenos AiresArgentina
  3. 3.Unidad de Cuidados Intensivos PediátricosSanatorio FranchinBuenos AiresArgentina
  4. 4.Unidad de Cuidados Intensivos PediátricosHospital de Niños de la Sma TrinidadCórdobaArgentina
  5. 5.Unidad de Cuidados Intensivos PediátricosHospital F AbeteBuenos AiresArgentina
  6. 6.Unidad de Cuidados Intensivos PediátricosHospital de Niños O AllasiaSanta FeArgentina
  7. 7.Unidad de Cuidados Intensivos PediátricosHospital de Niños Sor LudovicaLa Plata, Buenos AiresArgentina
  8. 8.Unidad de Cuidados Intensivos PediátricosHospital de Clinicas J de San MartinBuenos AiresArgentina
  9. 9.Unidad de Cuidados Intensivos PediátricosHospital de Niños P ElizaldeBuenos AiresArgentina
  10. 10.Unidad de Cuidados Intensivos PediátricosHospital El CruceFlorencio Varela, Buenos AiresArgentina
  11. 11.Unidad de Cuidados Intensivos PediátricosHospital del Niño JesúsSan Miguel de Tucumán, TucumánArgentina
  12. 12.Unidad de Cuidados Intensivos PediátricosHospital AustralPilar, Buenos AiresArgentina
  13. 13.Unidad de Cuidados Intensivos PediátricosSanatorio AnchorenaBuenos AiresArgentina
  14. 14.Unidad de Cuidados IntensivosHospital Universitario de GetafeMadridEspaña

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