Image: PD
1. Treatment with neuraminidase inhibitors, a subset of antivirals, was associated with decreased mortality in critically ill children with influenza.
2. Earlier treatment with neuraminidase inhibitors was linked to a significant greater reduction in mortality of critically ill children when compared to delayed treatment.
Evidence Rating Level: 2 (Good)
Study Rundown: The influenza virus poses a significant risk of morbidity and mortality for young children and the 2009 H1N1 influenza pandemic serving as a recent example. Despite the lack of evidence supporting the efficacy and safety of their use, neuraminidase inhibitors (NAI), a subset of antivirals, were part of the treatment regimens of 90% of children in intensive care units (ICUs) in California during the 2009 pandemic. This study evaluated the efficacy of NAIs on mortality among children admitted to ICUs with influenza during this period. Researchers also examined the correlation between timing of NAI treatment and mortality. Results revealed a significant reduction in mortality among critically ill children with influenza who received NAI treatment compared to those that did not. In addition, among those receiving an NAI, early treatment significantly decreased mortality compared with delayed treatment. This study was limited by its retrospective design and potential for selection bias, as very ill children, such as those admitted to the ICU, have been more likely to receive NAIs. These results support prompt use of NAIs in critically ill children with influenza; however, additional studies are necessary to confirm these findings.
Click to read the study, published today in Pediatrics
Relevant Reading: Centers for Disease Control and Prevention: Antiviral Agents for the Treatment and Chemoprophylaxis of Influenza
In-Depth [retrospective cohort]: This retrospective cohort study examined 748 hospitalized children, aged 0-17 years, with laboratory-confirmed influenza (median age = 6 years, 61% male), who were managed in the ICU during both the 2009 H1N1 flu pandemic and the following two influenza seasons in California. Of the children studied, 83% received NAI treatment. Mortality was the primary outcome investigated, with analysis completed to determine the potential differences in mortality among those who did and did not receive NAI. Additional analysis was completed to determine the differences between those who received treatment early (within 48 hours of symptom onset) compared to those who received it later (> 48 hours after symptom onset). Demographics, clinical characteristics and risk factors of the two cohorts were also analyzed and used in a multivariate analysis. NAI use in critically ill children with influenza was linked to decreased mortality when compared to those children who did not receive an NAI (6% mortality among those who received NAI v. 8% among those who did not; OR = 0.36, 95% CI 0.16-0.84). Earlier NAI treatment following symptom onset was also associated with decreased mortality compared to those treated later (3.5% mortality among those receiving early NAI treatment v. 5.3% of those treated later, p = .0002).
By Laurel Wickberg and Leah H. Carr
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