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Objective. To describe the clinical course of critically ill children with confirmed pandemic influenza A(H1N1)pdm09 (H1N1) infection in a southern African paediatric intensive care unit (PICU), and to compare them with a similar group with respiratory virus infections other than H1N1 admitted to the same PICU during the same period. Methods. A retrospective descriptive study of all patients admitted to a PICU in Cape Town, South Africa, who tested positive for H1N1 and other respiratory viruses from 1 August to 30 September 2009. Results. A total of 19 children in 20 PICU admissions tested positive for H1N1 (Group 1). Of these, 14 (70%) had major comorbidities and 4 tested positive for another respiratory virus. Five (26.3%) children in this group died and seven (36.8%) had nosocomial infection. Eight patients in nine PICU admissions who tested H1N1-negative (Group 2), tested positive for other respiratory viruses. Of these, five (55.6%) had major comorbidities. None in this group died. Children in Group 1 had significantly longer ICU stays, ventilator days and worse indices of organ dysfunction than those in Group 2.  Conclusions. Children admitted to the PICU with confirmed H1N1 tended to have longer ICU stays, prolonged ventilation, more severe organ dysfunction and higher mortality than those with other respiratory viruses. Hospitalisation was identified as a major risk factor for chronically ill children to acquire H1N1 infection requiring intensive care in our setting.

Influenza A(H1N1)pdm09 in critically ill children admitted to a paediatric intensive care unit, South Africa