Critically ill children during the 2009-2010 influenza pandemic in the United States

Adrienne G. Randolph, Frances Vaughn, Ryan Sullivan, Lewis Rubinson, B. Taylor Thompson, Grace Yoon, Elizabeth Smoot, Todd W. Rice, Laura L. Loftis, Mark Helfaer, Allan Doctor, Matthew Paden, Heidi Flori, Christopher Babbitt, Ana Lia Graciano, Rainer Gedeit, Ronald C. Sanders, John S. Giuliano, Jerry Zimmerman, Timothy M. Uyeki

Research output: Contribution to journalArticlepeer-review

183 Scopus citations


BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Original languageEnglish
Pages (from-to)e1450-e1458
Issue number6
StatePublished - Dec 2011


  • Influenza
  • Intensive care unit
  • MRSA
  • Mortality
  • Pandemic
  • Pediatric


Dive into the research topics of 'Critically ill children during the 2009-2010 influenza pandemic in the United States'. Together they form a unique fingerprint.

Cite this