Compare Of Clinical Character Between Severe And Critical Ill Children With Novel H1N1 Influenza

Objectives:To study different clinical characteristics and risk factors of severe and critical ill children with novel H1N1 influenza, then to guide prophylaxis and therapy.Methods:1.General dataSeventy-six children with novel H1N1 influenza were admitted to our hospital from Oct 1st 2009 to Dec 15th 2009, and their clinical data were collected. These cases consisted of 46 males and 30 females, the mean(SD) age was 3.29±2.90 years,25 cases (32.9%) were distributed in 0～1 years,17 cases (22.4%) in～3 years,18 cases (23.7%) in～5 years,16 cases (21.1%) in～16 years. According to《The third edition diagnosis and treatment program of novel H1N1 influenza》issued by the Health Department, the 76 cases were divided into 2 groups:severe group and critical group.2. MethodsAll the data collected by hand with uniform form included:physical data, vital signs, two kinds of scores, routine tests of blood, urine and stool, blood gas analysis, biochemistry, tests of cytoimmunity and humoral immunity and etc, all kinds of drugs, mechanical ventilation parameters and index of respiratory and circulation if mechanical ventilation received are also included.Dynamic checks of X-ray or CT were required to observe the imaging changes. According to the extent of the lesion involvement at the early phase of admission, the lesion was classified as three grade:mild (1～2 lung fields involved), moderate (3～41ung fields involved), and severe (5～6 lung fields involved). According to the lesion pattern, size, distribution and changes of lung marking, the lesion was classified as three types: consolidation type, interstitial infiltration type, mixed type.Cases of novel H1N1 influenza were confirmed by testing throat swabs with the use of a real time reverse transcriptase polymerase chain reaction (RT-PCR) assay at laboratory of SuZhou Center for Disease Control and Prevention (CDC).Results:1. The average age of severe cases (2.91±2.26 y) was significantly younger than that of critical cases (4.68±4.35 y)(P<0.05),60.0% of severe cases were younger than 3 years but in critical cases it is 37.5%, The median length of stay of severe cases (7.75±3.06 d) was significantly shorter than that of critical cases (19.6±7.72 d) (P<0.05), The severe cases had lower admission Pediatric Risk of Mortality ScoreⅢ(PRISMⅢScore) and higher Pediatrics Critical Illness Score (PCIS) than critical cases (P<0.05)2. Fever and cough were the common manifestations of the two groups, wheeze often occurred in severe cases, while inspiratory depression sign, ARDS, convulsion, coma and gastrointestinal bleeding were more often in critical cases.3. The proportion of coinfections in severe cases (68.3%) was higher than that in critical cases (37.5%) (P<0.05), SP (Streptococcus pneumoniae) was found common in severe cases, followed by Haemophilus influenzae and Moraxelle catarrhalis, while SA (Staphylococcus aureus) was found common in critical cases.4. Severe cases with pre-existing disease (31.6%) were less than critical cases (56.3%) (P<0.05), Asthma was the most common pre-existing disease in severe cases, followed by iron deficiency anemia, iron deficiency anemia was most common pre-existing disease in critical cases, followed by cerebral palsy and congenital heart disease.5. Oxygenation index (PaO2/FiO2) in severe cases (307.18±55.73) was significantly higher than those in critical cases (187.50±73.62)(P<0.05), Serum prealbumin (PA) and albumin (A) was significantly higher than those in critical cases (P<0.05), while the creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), a-hydroxybutyrate dehydrogenase (α-HBDH) and C-reactive protein (CRP) of severe cases were significantly lower than those of critical cases (P<0.05).6. Consolidation type are the main type of severe cases and critical cases, Air leak sign occurred more likely in critical cases than severe cases, the extent of lesion in severe cases presented as mild to moderate, and moderate to severe in critical cases.7. All the severe cases were improved and charged without any sequela, while in critical group,2 case died who were eight months and 3 years,3 cases were found pulmonary fibrosis and 2 cases found encephalatrophy at return visit, The median length of severe cases with positive real-time RT-PCR test results (6.96±3.01 d) was significantly shorter than that of critical cases (17.27±5.57 d) (P<0.05).Conclusion1. Critically ill children with novel H1N1 influenza were commonly older than severe cases, and usually have more organs being damaged.2. Laboratory tests (such as PaO2/FiO2, CK), imaging examination, PRISM III and PCIS score are helpful for severity and prognosis judgment.3. Children with iron deficiency anemia, cerebral palsy or congenital heart disease are easier to become critical cases.4. Different antibiotics should be chosen according to different bacteria spectrum of severe and critical cases.