1348 Influenza a H1N1 Virus Infection in a Pediactric Intensive Care Unit

Background: the main form of clinical presentation in critically ill patients with H1N1 infection is rapidly progressive respiratory failure, shock, neurological involvement and renal failure. Children with comorbidity and aged < 2 years are at particular risk. Methods: a descriptive, retrospective study on the clinical presentation and management of patients with H1N1 infection was performed in a Pediatric Intensive Care Unit (PICU). All children admitted in PICU of Coimbra's Pediatrics Hospital (CPH) were described, from July 15(th) to November 30(th) of 2009. Results: during this period, 241 children with laboratory confirmation of H1N1 infection were observed in CPH, of whom 38 (16%) required hospitalization, 4 (1.7%) in PICU-CPH. The age ranged from 4 months to 21 years. Three patients had previous co-morbidities. All met clinical criteria for H1N1 infection and were admitted with respiratory distress (4), rapidly progressive and evolution to ARDS (2), associated with shock (2) and lethargy (2). Three patients required mechanical ventilation (conventional and high-frequency oscillatory ventilation); the duration ranged between 4-12 days. Two patients received intravenous catecholamines support, two developed acute renal failure and two had pancytopenia. There were two bacterial coinfections. All received treatment with oseltamivir. Length of PICU stay ranged from 5-22 days, with a favorable outcome in all cases. Conclusion: in the 1st peak of H1N1 outbreak, 10% of the hospitalized children required PICU admission. Despite severe respiratory disease and multiple organ dysfunction, a good outcome was achieved, with no mortality.