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Hospitalized Children With Influenza A H1N1 (2009) Infection: A Spanish Multicenter Study

Hernández-Bou, Susanna MD*; Novell, Cristina Borrás MD*; Alins, Jara Guardia MD*; García-García, Juan José MD PhD

doi: 10.1097/PEC.0b013e31827b528f
Original Articles

Objectives Even though the majority of cases of influenza A H1N1 (2009) in children are mild, severe complications have been reported. Our objective was to describe the Influenza A H1N1 (2009) complications in pediatric population in Spain.

Methods This was a multicenter descriptive study including patients younger than 14 years attending 15 emergency departments and hospitalized with laboratory-confirmed influenza A H1N1 (2009) infection from August to December 2009. Patients who did not meet any of the admission criteria recommended by the Health Spanish Authorities were excluded. A standardized report form was used to collect information on demographics, risk factors, clinical and microbiological data, treatment, and outcome. Potential risk factors associated with intensive care requirement (assisted ventilation and/or inotropic support) were analyzed.

Results Three hundred eight patients were included. The hospitalization rate was 20.5 per 100,000 children younger than 14 years. Median age was 48 months; 21% had underlying medical conditions. The most common diagnosis at admission was presumed bacterial pneumonia (42.5%). Oseltamivir was prescribed on admission to 207 children (67.2%) and antibiotics to 199 (64.6%). Bacterial coinfection was confirmed in 29 patients (9.4%). Fifty-four patients (17.5%) were admitted to an intensive care unit, and 6 (1.9%) died. Logistic regression model revealed that confirmed bacterial coinfection was associated with intensive care requirement (odds ratio, 3.3; 95% confidence interval, 1.1–10.0).

Conclusions Respiratory manifestations were the main complication described. Although the majority of patients had a favorable evolution, a remarkable morbidity and mortality were observed. Patients with confirmed bacterial coinfection were at high risk of severe illness.

From the *Pediatric Emergency Department, and †Pediatric Department, Hospital Sant Joan de Déu Barcelona, Spain.

Disclosure: The authors declare no conflict of interest.

Reprints: Susanna Hernández-Bou, MD, Servei d’Urgències de Pediatria, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940 Esplugues de Llobregat (Barcelona), Spain (e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.