Clinical features, risk factors, and complications among pediatric patients with pandemic influenza A (H1N1).

OBJECTIVE: The authors aimed to describe the epidemiological characteristics, clinical features, risk factors for severe disease, and complications in children with laboratory-confirmed pandemic influenza A (H1N1). METHODS: H1N1 was confirmed by performing reverse-transcriptase polymerase chain reaction (RT-PCR) assay on oropharyngeal swab specimens. The medical charts of a subset of the evaluated patients were reviewed retrospectively; another subset was enrolled prospectively. RESULTS: A total of 51 patients (44 [86%] > 5 years) were identified to have laboratory-confirmed H1N1. Fever was the most common presenting symptom (92%). Of the 15 hospitalized patients, 4 had asthma, and 5 were overweight or obese. All but 1 of these 9 patients developed influenza-related complications. Overall, 10 of the 15 hospitalized patients (67%) developed an influenza-related complication (6 bronchitis and 4 pneumonia). CONCLUSION: In this cohort, most children with confirmed H1N1 infection experience an uncomplicated viral illness. Nevertheless, underlying asthma and obesity may aggravate their clinical course.

Sequential CT evaluation of isolated non-penetrating pancreatic trauma.

CONTEXT: Isolated pancreatic injuries resulting from non-penetrating trauma are rare. CT is currently the modality of choice in evaluating pancreatic injury. Delay in recognizing patients who need immediate surgery is an important cause of increased morbidity due to specific pancreatic complications. CASE REPORT: A 47-year-old man with blunt abdominal trauma after a car accident underwent a CT scan. Initial CT findings included diffuse pancreatic enlargement suggestive of isolated grade 1 pancreatic injury. A follow-up CT scan 3 days later revealed a fracture line at the pancreatic body. Subsequent surgical exploration confirmed the suspicion of concomitant duct transection. Seven months after surgery, a pseudocyst had formed adjacent to the site of the injury. CONCLUSIONS: This case demonstrates the potential importance of serial CT scans in the diagnosis, grading and management of isolated pancreatic injury.

Activity of the growth hormone/insulin-like growth factor-I axis in critically ill children.

Critical illness has an important impact on the human endocrine system. Very few studies have been performed to elucidate the alterations of the GH/IGF-I axis in acutely ill children. The aim of this study was to investigate several parameters of this axis in children with trauma (TRA) and sepsis (SEP) requiring admission to the pediatric intensive care unit (PICU). A total of 16 children, ten with TRA and six with SEP (age 1-10 years) as well as 18 healthy children (CS) of similar age and gender were included in the study. Two children, one with TRA and one with SEP, died. Serum IGF-I and -II, IGFBP-1 and -3, and GH levels were measured on days 1, 3 and 7 after admission. GH levels were higher in the patients than in CS (p = 0.04), with no difference between TRA and SEP, and were elevated during PICU stay (p = 0.05). Serum IGF-I, -II and IGFBP-3 were lower in the patients than in CS (p = 0.03, 0.02 and 0.001, respectively) with a tendency to increase up to day 7. Finally, IGFBP-1 levels were similar in the patients and CS. These findings indicate that critically ill children are characterized by low levels of IGF-I and -II as well as IGFBP-3 accompanied by elevated levels of GH, probably reflecting the development of peripheral GH resistance. No significant differences were found between the different catabolic conditions, sepsis and trauma.