Top risk factors identified for children during influenza pandemics

August 14, 2013, University of Auckland

Auckland medical scientists have helped to identify crucial risk factors for children most susceptible to life threatening infections from the H1N1 influenza virus.

Lead study author Dr Stuart Dalziel and senior research fellow Dr John Thompson from The University of Auckland worked with an international team of paediatric specialists to identify the risk factors.

It is the first study to detail which clinical factors in at hospital arrival with influenza-like illness and H1N1 infection, are associated with the progressive risk to either severe infection or death.

In the study, now on online in the prestigious British Medical Journal, researchers examined paediatric cases from dozens of emergency departments in hospitals around the world during the global of 2009.

The results enabled the team to pinpoint several clinical for severe infections in youngsters who arrive at a hospital with influenza-like illnesses due to H1N1 infections. The information would be invaluable during a pandemic, when emergency departments and primary-care facilities experience large surges of young patients who arrive with .

"The basic question clinicians face when they are in the middle of an like H1N1 is whether their patient is at risk of severe complications," says Stuart Dalziel, lead author and a paediatrician at New Zealand's Starship Children's Hospital and The University of Auckland, and Vice-Chair of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network.

"One of the key strengths of this study is that it provides clinicians with meaningful and more precise information that can enable them to identify those children with fever and flu-like symptoms who are at greater risk of severe complications," he says.

The findings stem from 265 pediatric cases culled from 79 emergency departments of hospitals associated with the Pediatric Emergency Research Networks (PERN) in 12 countries.

The study, which assessed each patient's clinical history and physical examination, identified the following predictors of severe H1N1 infection and potentially fatal outcomes in children:

  • History of chronic lung disease
  • History of cerebral palsy/developmental delay
  • Signs of chest retractions (difficulty breathing)
  • Signs of dehydration
  • Requires oxygen to keep blood levels normal
  • Heart rate that exceeds normal range (tachycardia) relative to age

"Having a more accurate idea of what to look for in paediatric cases, especially during a pandemic, would be especially important to clinicians because it provides crucial guidance for those who would be trying to direct the appropriate levels of treatment for many patients in a short time," said one of the study's co-authors Nathan Kuppermann, professor and chair of emergency medicine at the University of California.

Due to its unparalleled global network of hospitals and patient data, the PERN study also added weight to the efficacy and use of the anti-viral drug oseltamivir (trade name Tamiflu) to treat the children with H1N1 infections to reduce the severity of infection.

Researchers noted there was good evidence of an association between oseltamivir treatment and a reduced frequency of death in children admitted to an intensive care unit for assisted ventilation.

"This study shows the incredible power of PERN, bringing together five research networks and many emergency departments from around the world, to produce this very significant study which has the power to identify the most at-risk children in a future influenza pandemic," said Professor Terry P. Klassen, the study's senior author, CEO and scientific director at the Manitoba Institute of Child Health in Canada.

Explore further: Double dose of antiviral drug offers no added benefit in severe influenza

Related Stories

Double dose of antiviral drug offers no added benefit in severe influenza

May 30, 2013
Giving double doses of the antiviral drug oseltamivir, or Tamiflu, offers no clinical or virological advantages over a standard dose for patients admitted to hospital with severe influenza infection, according to a randomised ...

Early use of antiviral medications may help prevent lung failure in children with the flu, reduce hospitalizations

November 8, 2012
(Medical Xpress)—Children hospitalized for the flu are much less likely to require breathing support from a mechanical ventilator if they receive antiviral drugs like oseltamivir (Tamiflu) as soon as possible after admission, ...

Co-infections not associated with worse outcomes during H1N1 pandemic

April 9, 2013
A study at Rhode Island Hospital has found that despite complications, patients co-infected with the pandemic 2009-2010 influenza A H1N1 (pH1N1) and a second respiratory virus were not associated with worse outcomes or admission ...

Vaccinations alarmingly low for preventable childhood diseases

June 27, 2013
University of Sydney researchers have found alarmingly low rates of vaccination against chicken pox and influenza in children hospitalised for these diseases.

Why did healthy children fall critically ill in the 2009 H1N1 flu pandemic?

November 7, 2011
During the 2009 H1N1 influenza pandemic, many previously healthy children became critically ill, developing severe pneumonia and respiratory failure, sometimes fatal. The largest nationwide investigation to date of influenza ...

Use of simple rule in children's ankle injuries reduces use of radiography by 22 percent

August 12, 2013
Radiography is widely used in diagnosing ankle injuries, with 85%–95% in pediatric injuries, although only 12% of these show fractures.

Recommended for you

Building better tiny kidneys to test drugs and help people avoid dialysis

February 16, 2018
A free online kidney atlas built by USC researchers empowers stem cell scientists everywhere to generate more human-like tiny kidneys for testing new drugs and creating renal replacement therapies.

Expanding Hepatitis C testing to all adults is cost-effective and improves outcomes

February 16, 2018
According to a new study, screening all adults for hepatitis C (HCV) is a cost-effective way to improve clinical outcomes of HCV and identify more infected people compared to current recommendations. Using a simulation model, ...

Study suggests expanded range for emerging tick-borne disease

February 16, 2018
Human cases of Borrelia miyamotoi, a tick-borne infection with some similarities to Lyme disease, were discovered in the eastern United States less than a decade ago. Now new research led by the Yale School of Public Health ...

Flu shot only 36 percent effective, making bad year worse (Update)

February 15, 2018
The flu vaccine is doing a poor job protecting older Americans and others against the bug that's causing most illnesses.

IFN-mediated immunity to influenza A virus infection influenced by RIPK3 protein

February 15, 2018
Each year, influenza kills half a million people globally with the elderly and very young most often the victims. In fact, the Centers for Disease Control and Prevention reported 37 children have died in the United States ...

A new class of drug to treat herpes simplex virus-1 infection

February 14, 2018
For patients with the herpes simplex-1 virus (HSV-1), there are just a handful of drugs available to treat the painful condition that can affect the eyes, mouth and genitals.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.