Efecto del empleo de prescripciones informatizadas en la seguridad de pacientes pediátricos hospitalizados / Effect of electronic prescriptions on the safety of hospitalized pediatric patients

Introducción. Los errores en prescripción médica (EPM) son la causa más frecuente de errores prevenibles. El empleo de sistemas de prescripción informatizada (PI) contribuiría a disminuir el error y a mejorar la calidad de atención. Objetivos. Evaluar el efecto de la PI en la prevalencia de EPM y eventos adversos (EA) relacionados en pacientes pediátricos hospitalizados. Evaluar la adherencia, aceptabilidad y apropiabilidad de la herramienta por parte de los usuarios. Método. Diseño híbrido, descriptivo y cuasiexperimental tipo antes-después. Se incluyeron prescripciones médicas de pacientes hospitalizados, calculando la prevalencia de EPM y EA relacionados, en los períodos pre-y pos implementación de la PI en un hospital pediátrico (HP) y en uno general (HG) que se tomó como control. Se evaluó la adherencia mediante la proporción de las PI sobre las totales registradas en el período posimplementación. Se evaluó la aceptabilidad y apropiabilidad de la implementación por encuesta a los usuarios. Resultados. Al comparar la prevalencia de EPM pre- y posimplementación en el HP, se observó una disminución estadísticamente significativa en los dos hospitales: HP 29,1 versus 19,9 EPM/100 prescripciones (OR: 1,65; IC95 %: 1,34-2,02; p < 0,01). En el HG 24,9 versus 13,6 EPM/100 prescripciones (OR: 2,1; IC95 %: 1,5-2,8; p < 0,01). La tasa de adherencia global a la PI fue del 83 %. La implementación presentó aceptabilidad y apropiabilidad satisfactoria. Conclusión. La prevalencia de EPM se redujo un 30 % posimplementación. La adherencia global a la herramienta fue satisfactoria

Introduction. Prescription errors are the most common cause of preventable errors. Electronic prescription (EP) systems may help to reduce errors and improve the quality of care. Objectives. To assess the effect of EP on the prevalence of prescription errors and related adverse events (AE) among hospitalized pediatric patients. To assess EP adherence, acceptability, and suitability among users. Method. Hybrid, descriptive, and quasi-experimental, before-and-after design. Prescriptions made to hospitalized patients were included, estimating the prevalence of prescription errors and related AE in the pre- and post- EP implementation periods at a children's hospital (CH) and a general hospital (GH) used as control. Adherence was assessed based on the proportion of EP among all prescriptions registered in the post-implementation period. The acceptability and suitability of EP implementation was assessed via a user survey. Results. The prevalence of prescription errors pre- and post-EP implementation at the CH was compared and a statistically significant reduction was observed in both hospitals: CH: 29.1 versus 19.9 prescription errors/100 prescriptions (OR: 1.65; 95% CI: 1.34-2.02;p < 0.01). GH: 24.9 versus 13.6 prescription errors/100 prescriptions (OR: 2.1; 95% CI: 1.5-2.8; p < 0.01). The rate of overall adherence to EP was 83%. The implementation of EP was adequately acceptable and suitable. Conclusion. The prevalence of prescription errors reduced 30% after the implementation of EP. The overall adherence to EP was adequate.

Effect of electronic prescriptions on the safety of hospitalized pediatric patients. / Efecto del empleo de prescripciones informatizadas en la seguridad de pacientes pediátricos hospitalizados.

INTRODUCTION: Prescription errors are the most common cause of preventable errors. Electronic prescription (EP) systems may help to reduce errors and improve the quality of care. OBJECTIVES: To assess the effect of EP on the prevalence of prescription errors and related adverse events (AE) among hospitalized pediatric patients. To assess EP adherence, acceptability, and suitability among users. METHODS: Hybrid, descriptive, and quasi-experimental, before-and-after design. Prescriptions made to hospitalized patients were included, estimating the prevalence of prescription errors and related AE in the pre- and post- EP implementation periods at a children's hospital (CH) and a general hospital (GH) used as control. Adherence was assessed based on the proportion of EP among all prescriptions registered in the post-implementation period. The acceptability and suitability of EP implementation was assessed via a user survey. RESULTS: The prevalence of prescription errors pre- and post-EP implementation at the CH was compared and a statistically significant reduction was observed in both hospitals: CH: 29.1 versus 19.9 prescription errors/100 prescriptions (OR: 1.65; 95% CI: 1.34-2.02; p < 0.01). GH: 24.9 versus 13.6 prescription errors/100 prescriptions (OR: 2.1; 95% CI: 1.5-2.8; p < 0.01). The rate of overall adherence to EP was 83%. The implementation of EP was adequately acceptable and suitable. CONCLUSION: The prevalence of prescription errors reduced 30% after the implementation of EP. The overall adherence to EP was adequate.

Introducción. Los errores en prescripción médica (EPM) son la causa más frecuente de errores prevenibles. El empleo de sistemas de prescripción informatizada (PI) contribuiría a disminuir el error y a mejorar la calidad de atención. Objetivos. Evaluar el efecto de la PI en la prevalencia de EPM y eventos adversos (EA) relacionados en pacientes pediátricos hospitalizados. Evaluar la adherencia, aceptabilidad y apropiabilidad de la herramienta por parte de los usuarios. Método. Diseño híbrido, descriptivo y cuasiexperimental tipo antes-después. Se incluyeron prescripciones médicas de pacientes hospitalizados, calculando la prevalencia de EPM y EA relacionados, en los períodos pre-y posimplementación de la PI en un hospital pediátrico (HP) y en uno general (HG) que se tomó como control. Se evaluó la adherencia mediante la proporción de las PI sobre las totales registradas en el período posimplementación. Se evaluó la aceptabilidad y apropiabilidad de la implementación por encuesta a los usuarios. Resultados. Al comparar la prevalencia de EPM pre- y posimplementación en el HP, se observó una disminución estadísticamente significativa en los dos hospitales: HP 29,1 versus 19,9 EPM/100 prescripciones (OR: 1,65; IC95 %: 1,34-2,02; p < 0,01). En el HG 24,9 versus 13,6 EPM/100 prescripciones (OR: 2,1; IC95 %: 1,5-2,8; p < 0,01). La tasa de adherencia global a la PI fue del 83 %. La implementación presentó aceptabilidad y apropiabilidad satisfactoria. Conclusión. La prevalencia de EPM se redujo un 30 % posimplementación. La adherencia global a la herramienta fue satisfactoria.

Detección de eventos adversos en pacientes pediátricos hospitalizados mediante la herramienta de disparadores globales Global Trigger Tool / Measuring adverse events in pediatric inpatients with the Global Trigger Tool

Introducción: La seguridad del paciente hospitalizado es prioritaria para el sistema de salud. La herramienta de disparadores globales parecería ser adecuada para estimar la incidencia de eventos adversos (EA) en niños hospitalizados. Objetivos: Describir la incidencia y la categorización de EA en niños hospitalizados utilizando la herramienta de disparadores globales e identificar los factores de riesgo asociados a su aparición. Población y métodos: Estudio retrospectivo. Se incluyeron 200 historias clínicas de pacientes internados en el Hospital Elizalde en el año 2013. Variables de resultado: número de EA/100 ingresos y distribución del dano. Se utilizó la prueba de chi cuadrado, la prueba de t y la correlación de Pearson. Nivel de significación de p < 0,05. Resultados: Se detectaron 289 disparadores (1,4/paciente); 52 EA (26 EA cada 100 pacientes, IC 95%: 20,4-32,5). Presentaron, al menos, un EA 36 pacientes; 7 pacientes sufrieron más de uno; 45 EA fueron categoría E y F (dano temporario). Los disparadores de cuidados médicos se asociaron con EA (OR 8,1; IC 95%: 3,7-17,3; p < 0,001). Se encontró una correlación positiva entre el número de disparadores y el número de EA por paciente (R= 0,46; p < 0,001). Los pacientes internados en unidad cerrada (OR 2,8; IC 95%: 1,2-6,5; p= 0,03) y el mayor promedio de días de internación se asociaron a EA (p < 0,001). Conclusión: Se identificó una frecuencia de 26% de EA; la mayoría fue dano temporario. La internación en una unidad cerrada, la mayor cantidad de días de internación, el mayor número de disparadores y los disparadores de cuidados generales se asociaron con la presencia de EA.

Introduction: The safety of inpatients is a priority in the health care system. The Global Trigger Tool seems to be suitable to estimate the incidence of adverse events (AE) in pediatric inpatients. Objectives: To describe the incidence and categories of AE in pediatric inpatients using the Global Trigger Tool and to identify risk factors associated to their development. Population and methods: Retrospective study. Medical records of 200 patients hospitalized at Hospital Elizalde during 2013 were included. Outcome measures: number of AE/100 admissions and distribution of harm. A chi² test, Student's t test and Pearson's correlation test were carried out. Significance level = p < 0.05. Results: The study detected 289 triggers (1.4/patient); 52 AEs (26 AEs/100 patients, 95% CI: 20.4-32.5). There was at least one AE every 36 patients; 7 patients had more than one AE; 45 AEs were in the E and F categories (temporary harm). Medical care triggers were associated to AEs (OR 8.1; 95% CI: 3.7-17.3, p < 0.001). A positive correlation was found between the number of triggers and the number of AEs per patient (R= 0.46; p < 0.001). Being hospitalized in a closed unit (OR 2.8; 95% CI: 1.2-6.5; p= 0.03) and a longer hospital stay were associated to AEs (p < 0.001). Conclusion: An AE frequency of 26% was identified, and most AEs resulted in temporary harm. The presence of AEs was associated to hospitalization in a closed unit, longer hospital stay, higher number of triggers and general care triggers.

Measuring adverse events in pediatric inpatients with the Global Trigger Tool. / Detección de eventos adversos en pacientes pediátricos hospitalizados mediante la herramienta de disparadores globales Global Trigger Tool.

INTRODUCTION: The safety of inpatients is a priority in the health care system. The Global Trigger Tool seems to be suitable to estimate the incidence of adverse events (AE) in pediatric inpatients. OBJETIVES: To describe the incidence and categories of AE in pediatric inpatients using the Global Trigger Tool and to identify risk factors associated to their development. POPULATION AND METHODS: Retrospective study. Medical records of 200 patients hospitalized at Hospital Elizalde during 2013 were included. Outcome measures: number of AE/100 admissions and distribution of harm. A chi² test, Student´s t test and Pearson's correlation test were carried out. Significance level = p < 0.05. RESULTS: The study detected 289 triggers (1.4/patient); 52 AEs (26 AEs/100 patients, 95% CI: 20.4-32.5). There was at least one AE every 36 patients; 7 patients had more than one AE; 45 AEs were in the E and F categories (temporary harm). Medical care triggers were associated to AEs (OR 8.1; 95% CI: 3.7-17.3, p < 0.001). A positive correlation was found between the number of triggers and the number of AEs per patient (R= 0.46; p < 0.001). Being hospitalized in a closed unit (OR 2.8; 95% CI: 1.2-6.5; p= 0.03) and a longer hospital stay were associated to AEs (p < 0.001). CONCLUSION: An AE frequency of 26% was identified, and most AEs resulted in temporary harm. The presence of AEs was associated to hospitalization in a closed unit, longer hospital stay, higher number of triggers and general care triggers.

INTRODUCCIÓN: La seguridad del paciente hospitalizado es prioritaria para el sistema de salud. La herramienta de disparadores globales parecería ser adecuada para estimar la incidencia de eventos adversos (EA) en niños hospitalizados. OBJETIVOS: Describir la incidencia y la categorización de EA en niños hospitalizados utilizando la herramienta de disparadores globales e identificar los factores de riesgo asociados a su aparición. POBLACIÓN Y MÉTODOS: Estudio retrospectivo. Se incluyeron 200 historias clínicas de pacientes internados en el Hospital Elizalde en el año 2013. Variables de resultado: número de EA/100 ingresos y distribución del daño. Se utilizó la prueba de chi cuadrado, la prueba de t y la correlación de Pearson. Nivel de significación de p < 0,05. RESULTADOS: Se detectaron 289 disparadores (1,4/paciente); 52 EA (26 EA cada 100 pacientes, IC 95%: 20,4-32,5). Presentaron, al menos, un EA 36 pacientes; 7 pacientes sufrieron más de uno; 45 EA fueron categoría E y F (daño temporario). Los disparadores de cuidados médicos se asociaron con EA (OR 8,1; IC 95%: 3,7-17,3; p < 0,001). Se encontró una correlación positiva entre el número de disparadores y el número de EA por paciente (R= 0,46; p < 0,001). Los pacientes internados en unidad cerrada (OR 2,8; IC 95%: 1,2-6,5; p= 0,03) y el mayor promedio de días de internación se asociaron a EA (p < 0,001). CONCLUSIÓN: Se identificó una frecuencia de 26% de EA; la mayoría fue daño temporario. La internación en una unidad cerrada, la mayor cantidad de días de internación, el mayor número de disparadores y los disparadores de cuidados generales se asociaron con la presencia de EA.

Impact of a brief intervention on the burnout levels of pediatric residents.

OBJECTIVES: To estimate burnout prevalence among pediatric residents and to evaluate the impact of a brief intervention aimed at controlling burnout. METHODS: A randomized controlled trial was conducted on 74 pediatric residents. The Maslach Burnout Inventory was administered to all subjects, and demographic information was gathered (age, gender, children, cohabitants, and residency year). The experimental group (n = 37) participated in self-care workshops over the course of 2 months, and the control group (n = 37) did not receive any intervention. After the intervention, the Maslach Burnout Inventory was administered again to all participants. All potential predictors of burnout were included in a logistic regression model. The efficacy of the intervention was evaluated by the chi-square test. P values < 0.05 were considered significant. RESULTS: The burnout prevalence among pediatric residents was 66%. After controlling for age, gender, children, and cohabitants, the prevalence of burnout was significantly higher among third-year residents (odds ratio = 11.8; 95% confidence interval 2.3-59.3; p = 0.003). There were no significant differences regarding burnout prevalence in the experimental group between the baseline and post-intervention periods (p = 0.8) or between the two groups after intervention (p = 0.8). The only difference observed was an improvement regarding "depersonalization" in the experimental group (p = 0.031). CONCLUSIONS: The burnout prevalence among pediatric residents was 66% and was higher among third-year residents. A brief intervention was not effective in reducing burnout prevalence, despite the achievement of an improvement in "depersonalization."

Impacto de uma intervenção breve nos níveis de burnout de residentes pediátricos / Impact of a brief intervention on the burnout levels of pediatric residents

OBJETIVOS: Estimar a prevalência de burnout entre residentes pediátricos e avaliar o impacto de uma intervenção breve voltada para o controle da doença. MÉTODOS: Foi realizado um estudo controlado randomizado em 74 residentes de pediatria. Todos preencheram o Inventário de Burnout de Maslach, e foram coletadas informações demográficas (idade, sexo, filhos, coabitantes e ano de residência). O grupo experimental (n = 37) participou de oficinas de autocuidado durante 2 meses, e o grupo controle (n = 37) não recebeu nenhuma intervenção. Após a intervenção, os participantes preencheram novamente o Inventário de Burnout de Maslach. Todos os potenciais preditores de burnout foram incluídos em um modelo de regressão logística. A eficácia da intervenção foi avaliada pelo teste qui-quadrado. Os valores p < 0,05 foram considerados significativos. RESULTADOS: A prevalência de burnout entre residentes pediátricos foi de 66%. Após controle para idade, gênero, filhos e coabitantes, a prevalência de burnout foi maior entre residentes do terceiro ano (razão de chances = 11,8; intervalo de confiança de 95% 2,3-59,3; p = 0,003). Não foram encontradas diferenças significativas na prevalência de burnout no grupo experimental entre os períodos inicial e pós-intervenção (p = 0,8) ou entre os dois grupos após a intervenção (p = 0,8). A única diferença observada foi uma melhora quanto à "despersonalização", no grupo experimental (p = 0,031). CONCLUSÕES: A prevalência de burnout entre residentes pediátricos foi de 66%, sendo maior entre os residentes do terceiro ano. Uma intervenção breve não foi eficaz na redução da prevalência de burnout, apesar da melhora no quesito "despersonalização".

OBJECTIVES: To estimate burnout prevalence among pediatric residents and to evaluate the impact of a brief intervention aimed at controlling burnout. METHODS: A randomized controlled trial was conducted on 74 pediatric residents. The Maslach Burnout Inventory was administered to all subjects, and demographic information was gathered (age, gender, children, cohabitants, and residency year). The experimental group (n = 37) participated in self-care workshops over the course of 2 months, and the control group (n = 37) did not receive any intervention. After the intervention, the Maslach Burnout Inventory was administered again to all participants. All potential predictors of burnout were included in a logistic regression model. The efficacy of the intervention was evaluated by the chi-square test. P values < 0.05 were considered significant. RESULTS: The burnout prevalence among pediatric residents was 66%. After controlling for age, gender, children, and cohabitants, the prevalence of burnout was significantly higher among third-year residents (odds ratio = 11.8; 95% confidence interval 2.3-59.3; p = 0.003). There were no significant differences regarding burnout prevalence in the experimental group between the baseline and post-intervention periods (p = 0.8) or between the two groups after intervention (p = 0.8). The only difference observed was an improvement regarding "depersonalization" in the experimental group (p = 0.031). CONCLUSIONS: The burnout prevalence among pediatric residents was 66% and was higher among third-year residents. A brief intervention was not effective in reducing burnout prevalence, despite the achievement of an improvement in "depersonalization.".

[Validation of a clinical prediction rule to distinguish bacterial from aseptic meningitis]. / Validación de una regla de predicción clínica para diferenciar meningitis bacteriana de meningitis aséptica.

INTRODUCTION: Despite most meningitis are not bacterial, antibiotics are usually administered on admission because bacterial meningitis is difficult to be rule-out. Distinguishing bacterial from aseptic meningitis on admission could avoid inappropriate antibiotic use and hospitalization. We aimed to validate a clinical prediction rule to distinguish bacterial from aseptic meningitis in children, on arriving to the emergency room. METHODS: This prospective study included patients aged < 19 years with meningitis. Cerebrospinal fluid (CSF) and peripheral blood neutrophil count were obtained from all patients. The BMS (Bacterial Meningitis Score) described by Nigrovic (Pediatrics 2002; 110: 712), was calculated: positive CSF Gram stain= 2 points, CSF absolute neutrophil count > or = 1000 cells/mm(3), CSF protein > or = 80 mg/dl, peripheral blood absolute neutrophil count > or = 10.000/mm(3), seizure = 1 point each. Sensitivity (S), specificity (E), positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (PLR and NLR) of the BMS to predict bacterial meningitis were calculated. RESULTS: Seventy patients with meningitis were included (14 bacterial meningitis). When BMS was calculated, 25 patients showed a BMS= 0 points, 11 BMS= 1 point, and 34 BMS > or = 2 points. A BMS = 0 showed S: 100%, E: 44%, VPP: 31%, VPN: 100%, RVP: 1,81 RVN: 0. A BMS > or = 2 predicted bacterial meningitis with S: 100%, E: 64%, VPP: 41%, VPN: 100%, PLR: 2.8, NLR:0. CONCLUSIONS: Using BMS was simple, and allowed identifying children with very low risk of bacterial meningitis. It could be a useful tool to assist clinical decision making.

Validación de una regla de predicción clínica para diferenciar meningitis bacteriana de meningitis aséptica / Validation of a clinical prediction rule to distinguish bacterial from aseptic meningitis

La mayoría de las meningitis en la infancia no son bacterianas, pero la dificultad en descartar tal etiología obliga con frecuencia a utilizar antibióticos inicialmente. El objetivo de este trabajo fue validar, en nuestro medio, una regla de predicción clínica para diferenciar la etiología de las meningitis en niños a su ingreso al hospital. Método. Estudio prospectivo que incluyó pacientes menores 19 años de edad con diagnósitco de meningitis. En todos se obtuvo líquido cefalorraquídeo (LCR) para análisis directo, citoquímico y cultivo, y hemograma. Se calculó el BMS (Bacterial Meningitis Score: puntaje de meningitis basteriana) descripto por Nigrovic (Pediatrics 2002; 110:712): tinción de Gram en LCR positiva = 2 puntos; proteinorraquia mayor o igual 80 mg/dl, neutrófilos en sangre periférica mayor o igual 10000/mn3, neutrofilos en LCR mayor o igual 1000/mm3, convulsiones, un punto cada uno. Se calculó sensibilidad (S), especificidad (E), valores predictivos positivo y negativo (VPP y VPN) y razones de verosimilitud positiva y negativa (RVP y RVN)del BMS para predecir meningitis bacteriana. Resultados. Se incluyeron 70 pacientes con meningitis (14 bacterianas) veinticinco pacientes presentaron BMS=0 puntos, 11 BMS=1 punto, y 34 BMS mayor o igual 2 puntos. Un BMS=0 evidenció S: 100 por ciento E: 44 por ciento, VPP; 31 por ciento, VPN: 100 por ciento, RVP: 1,81 RVN: 0 para predecir meningitis bacteriana. Un BMS mayor o igual 2 mostró S: 100 por ciento, E: 64 por ciento, VPP: 41 por ciento, VPN: 100 por ciento, RVP: 2,8 RVN: 0 para predecir meningitis bacteriana. Conclusión: La utilización del BMS fue simple y permitió identificar pacientes con bajo riesgo de meningitis bacteriana. Su empleo podría constituir una herramienta útil en la toma de decisiones clínicas.

Validación de una regla de predicción clínica para diferenciar meningitis bacteriana de meningitis aséptica / Validation of a clinical prediction rule to distinguish bacterial from aseptic meningitis

La mayoría de las meningitis en la infancia no son bacterianas, pero la dificultad en descartar tal etiología obliga con frecuencia a utilizar antibióticos inicialmente. El objetivo de este trabajo fue validar, en nuestro medio, una regla de predicción clínica para diferenciar la etiología de las meningitis en niños a su ingreso al hospital. Método. Estudio prospectivo que incluyó pacientes menores 19 años de edad con diagnósitco de meningitis. En todos se obtuvo líquido cefalorraquídeo (LCR) para análisis directo, citoquímico y cultivo, y hemograma. Se calculó el BMS (Bacterial Meningitis Score: puntaje de meningitis basteriana) descripto por Nigrovic (Pediatrics 2002; 110:712): tinción de Gram en LCR positiva = 2 puntos; proteinorraquia mayor o igual 80 mg/dl, neutrófilos en sangre periférica mayor o igual 10000/mn3, neutrofilos en LCR mayor o igual 1000/mm3, convulsiones, un punto cada uno. Se calculó sensibilidad (S), especificidad (E), valores predictivos positivo y negativo (VPP y VPN) y razones de verosimilitud positiva y negativa (RVP y RVN)del BMS para predecir meningitis bacteriana. Resultados. Se incluyeron 70 pacientes con meningitis (14 bacterianas) veinticinco pacientes presentaron BMS=0 puntos, 11 BMS=1 punto, y 34 BMS mayor o igual 2 puntos. Un BMS=0 evidenció S: 100 por ciento E: 44 por ciento, VPP; 31 por ciento, VPN: 100 por ciento, RVP: 1,81 RVN: 0 para predecir meningitis bacteriana. Un BMS mayor o igual 2 mostró S: 100 por ciento, E: 64 por ciento, VPP: 41 por ciento, VPN: 100 por ciento, RVP: 2,8 RVN: 0 para predecir meningitis bacteriana. Conclusión: La utilización del BMS fue simple y permitió identificar pacientes con bajo riesgo de meningitis bacteriana. Su empleo podría constituir una herramienta útil en la toma de decisiones clínicas.(AU)

Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina.

BACKGROUND: While the Northern Hemisphere experiences the effects of the 2009 pandemic influenza A (H1N1) virus, data from the recent influenza season in the Southern Hemisphere can provide important information on the burden of disease in children. METHODS: We conducted a retrospective case series involving children with acute infection of the lower respiratory tract or fever in whom 2009 H1N1 influenza was diagnosed on reverse-transcriptase polymerase-chain-reaction assay and who were admitted to one of six pediatric hospitals serving a catchment area of 1.2 million children. We compared rates of admission and death with those among age-matched children who had been infected with seasonal influenza strains in previous years. RESULTS: Between May and July 2009, a total of 251 children were hospitalized with 2009 H1N1 influenza. Rates of hospitalization were double those for seasonal influenza in 2008. Of the children who were hospitalized, 47 (19%) were admitted to an intensive care unit, 42 (17%) required mechanical ventilation, and 13 (5%) died. The overall rate of death was 1.1 per 100,000 children, as compared with 0.1 per 100,000 children for seasonal influenza in 2007. (No pediatric deaths associated with seasonal influenza were reported in 2008.) Most deaths were caused by refractory hypoxemia in infants under 1 year of age (death rate, 7.6 per 100,000). CONCLUSIONS: Pandemic 2009 H1N1 influenza was associated with pediatric death rates that were 10 times the rates for seasonal influenza in previous years.