Chulalongkorn Medical Journal


Objective : To study the clinical presentations and outcomes of 2009 influenzaA (H1N1) pneumonia children at King Chulalongkorn Memorial Hospital.Setting : Department of Pediatrics, King Chulalongkorn Memorial Hospital.Research design : Descriptive study.Patients Pediatric patients aged 1 month - 18 years who were admitted due toH1N1 influenza pneumonia between June 2009 – March 2010.Methods : All the pediatric patients with pneumonia who had laboratoryconfirmation of 2009 influenza A (H1N1) infection by positive real-timereverse-transcriptase polymerase chain reaction (RT-PCR) assay forH1N1 influenza A virus in their nasopharyngeal aspirates or combinednasal and throat swabs were studied. Their demographic data, clinicalpresentations, laboratory results, radiological findings and clinicaloutcomes were analyzed.Results : There were 37 patients with confirmed 2009 influenza A (H1N1)pneumonia during the study period. Male: female was 1.3: 1.The mean age was 6.4 ± 4.7 years (ranged 2 months - 16 years).Twenty-one patients (56.8%) had underlying diseases. Chronic lungdisease and hematologic malignancy were the two most commonunderlying conditions. Only 43.2% of the patients (16/37 cases) hadcontact history and 7 cases got the infection while being in the hospital.The most common presenting symptoms were fever and cough (94.6%).Most of the patients had had fever with a mean temperature of 38.6 ± 0.9C (ranged 36.3 – 40.4C) for 50.0 ± 35.8 hours prior tohospitalization or diagnosis. The mean white blood cell count were7,671 ± 623 cells/mm.3 The most common chest X-ray finding wasperihilar interstitial infiltration (62.2%) while patchy infiltration wasnoted in 13.5% of the patients. Ten cases (27%) had hypoxemia and4 cases (10.8%) with underlying conditions developed into acuterespiratory failure. Two patients (5.4%) died due to ARDS and severesepsis.Conclusion : Fever and cough with perihilar infiltrations were the most commonclinical presentations of 2009 influenza A (H1N1) pneumonia inchildren admitted at King Chulalongkorn Memorial Hospital duringthe pandemic period. Respiratory failure occurred in patients withunderlying diseases and accounted for 10.8% leading to a mortalityrate of 5.4%. ARDS and superimposed bacterial infections werethe major causes of death in this study.


Faculty of Medicine, Chulalongkorn University

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