Kids with chronic respiratory illness vulnerable to critical H1N1

Washington, Mar 12 : Children with chronic illness, especially respiratory illness, are more likely to develop H1N1 influenza, concludes a new study.

The study has been published in the March issue of Pediatric Critical Care Medicine (PCCM).

The H1N1 study focusing exclusively on critically ill children found that children with chronic illness, especially respiratory illness, are more likely to develop H1N1 influenza that requires critical care and that the virus is likely to change course as it attacks the lungs throughout the course of the illness.

"The good news is that all of our patients survived, even though some needed mechanical ventilators and heart medication," said senior author David G. Nichols, MD, professor of anesthesiology/critical care medicine and pediatrics at the Johns Hopkins University School of Medicine.

Compared to seasonal influenza, H1N1 influenza appears to have increased infection rates among children and young adults and varies in severity.

To reach the conclusion, researchers reviewed cases of 13 critically ill children with H1N1 admitted to the Johns Hopkins Hospital Children''s Center pediatric intensive care unit during the spring and summer of 2009.

They found that the vast majority (92 percent) of the children had an underlying chronic disease, usually a lung disease such as asthma, before contracting H1N1 infection.

"Critical H1N1 disease in children has different and rapidly changing manifestations in the patients'' lungs," explained Dr. Nichols. "Some children behaved as though they were having an asthma attack, while other children behaved as though they had severe pneumonia. Some children had both or switched from one to the other. These variable and changing manifestations of lung infection made life support with a mechanical ventilator challenging and required us to constantly reassess and readjust treatments."

The researchers also found that children with H1N1 lung disease are at increased risk for developing a second type of pneumonia.

Patients who received treatment with antiviral drugs such as Tamiflu within 48 hours of admission did not have significantly different outcomes than those who received antiviral treatment more than 48 hours following admission.