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Klin Padiatr 2011; 223(05): 267-270
DOI: 10.1055/s-0031-1285840
Rapid Communication
George Thieme Verlag KG Stuttgart · New York

Pandemic A/H1N1(2009) Influenza Infections in Very-Low-Birth-Weight Infants – a Case Series from the German Neonatal Network

Influenza-A/H1N1(2009)-Infektionen bei Frühgeborenen mit einem Geburtsgewicht unter 1500 g – eine Fallserie aus dem Deutschen Frühgeborenen-Netzwerk
A. Stein   *
1   Department of Pediatrics I, Neonatology, University Hospital Essen, Germany
,
M. Keller   *
1   Department of Pediatrics I, Neonatology, University Hospital Essen, Germany
,
S. Ross
2   Institute of Virology, University Hospital Essen, Germany
,
M. Roggendorf
2   Institute of Virology, University Hospital Essen, Germany
,
F. Heitmann
3   Department of Pediatrics, Community Hospital Dortmund, Germany
,
T. Hoehn
4   Department of General Pediatrics, University Hospital Duesseldorf, Germany
,
W. Göpel
5   Department of Pediatrics, University of Luebeck, Germany
,
U. Felderhoff-Müser
1   Department of Pediatrics I, Neonatology, University Hospital Essen, Germany
,
C. Härtel
5   Department of Pediatrics, University of Luebeck, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
12 September 2011 (online)

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Abstract

6 cases of clinical influenza A/H1N1(2009) infections were reported within the multi-center German Neonatal Network (GNN) during the primary hospital stay in the pandemic season 2009/2010 and 2010/2011. Clinical symptoms varied from transient hyperthermia to apnea and severe respiratory distress. 1 fatal course with systemic inflammatory response after perinatal transmission of A/H1N1(2009) was observed. Oseltamivir treatment in 3/6 infants was without side effects. The reported cases have major implications for the management of VLBW infants: i) fatal courses after perinatal transmission are possible, ii) postnatal A/H1N1(2009) infection may result in life threatening events at a time when the infant is otherwise stable, iii) vaccination should be recommended for parents and medical staff to avoid nosocomial transmission, iv) more data are needed on the benefit and harm of antiviral drugs in preterm infants, v) neonatologists should suspect A/H1N1(2009) infection when unexplained sepsis-like or respiratory symptoms occur in VLBW infants.

Zusammenfassung

Innerhalb des Deutschen Frühgeborenen-Netzwerkes (GNN – German Neonatal Network) wurden 6 Fälle einer Influenza-A/H1N1(2009)-Infektion in der pandemischen Saison 2009/2010 und 2010/2011 bei sehr kleinen Frühgeborenen während des primären Krankenhausaufenthaltes registriert. Die Symptome reichten von milder transienter Temperaturerhöhung und gehäuften Apnoen bis hin zu schwerer Atemnot. Ein tödlicher Verlauf mit schwerer systemischer Inflammationsreaktion wurde bei perinataler Transmission von A/H1N1(2009) beobachtet. Die Therapie mit Oseltamivir bei 3/6 Frühgeborenen zeigte keine Nebenwirkungen. Für das zukünftige Management extrem kleiner Frühgeborener lassen sich aus dieser Fallsammlung folgende Schlüsse ziehen: i) tödliche Verläufe nach perinataler Transmission sind möglich, ii) postnatale A/H1N1(2009)-Infektionen können auch bei eigentlich stabilen Kindern zu schweren Verläufen mit respiratorischem Versagen führen, iii) die Grippeschutzimpfung sollte Personal, Eltern und Besuchern einer neonatologischen Station zur Vermeidung nosokomialer Infektionen nahegelegt werden, iv) zur antiviralen Therapie kleiner Frühgeborener werden zusätzliche Daten zu Pharmakologie und Sicherheit benötigt, v) bei respiratorischen oder sepsisähnlichen Symptomen bei Frühgeborenen sollte eine Influenza-A/H1N1(2009)-Infektion in die Differenzialdiagnose mit einbezogen werden.

Key words

VLBW infants - influenza - H1N1 - oseltamivir - nosocomial infection - premature infants

Schlüsselwörter

extrem unreife Frühgeborene - Influenza - H1N1 - Oseltamivir - nosokomiale Infektion - Frühgeborene
*

* equal contribution


Supplementary Material

 

  • References

  • 1 Acosta EP, Jester P, Gal P et al. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group: Oseltamivir dosing for influenza infection in premature neonates. J Infect Dis 2010; 202: 563-566
    CrossrefPubMedGoogle Scholar
  • 2 American Academy of Pediatrics Subcommittee on Diagnosis Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics 2006; 118: 1774-1793
    CrossrefPubMedGoogle Scholar
  • 3 Bailhache M, Sarlangue J, Castella C et al. Influenza A(H1N1)v virus infection in infants less than 6 months of age in southwestern France. Arch Pediatr 2011; 18: 383-389 [article in French]
    CrossrefPubMedGoogle Scholar
  • 4 Barak S, Kushnir A, Chulski E et al. Influenza A/H1N1 virus in very low-birth-weight premature infant: case report. Am J Perinatol 2010; 27: 513-515
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Centers for Disease Control Prevention. What Should Pregnant Women Know About 2009 H1N1 Flu (Swine Flu). http://www.cdc.gov/h1n1flu/guidance/pregnant.htm Updated October 19 2009
    PubMedGoogle Scholar
  • 6 Cheng PKC, Leung TWC, Ho ECM et al. Oseltamivir- and amantadine-resistant influenza viruses A (H1N1). Emerg Infect Dis 2009; 15: 966-968
    CrossrefPubMedGoogle Scholar
  • 7 Gärtner B. Influenza Diagnostik. Klin Padiatr 2010; 222 DOI: 10.1055/s-0030-1261405.
    PubMedGoogle Scholar
  • 8 Gilsdorf A, Poggensee G. Working Group Pandemic Influenza A (H1N1)v: Influenza A (H1N1)v in Germany: the first 10000 cases. Euro Surveill 2009; 14 pii: 19318
    PubMedGoogle Scholar
  • 9 Keller M, Ross S, Thuma M. Symptomatische Infektion mit Influenza H1N1 bei einem Frühgeborenen. Klin Padiatr 2010; 222 DOI: 10.1055/s-0030-1261426.
    PubMedGoogle Scholar
  • 10 Kitching A, Roche A, Balasegaram S et al. Oseltamivir adherence and side effects among children in three London schools affected by influenza A (H1N1)v, May 2009 – an internet-based cross-sectional survey. Euro Surveill 2009; 14 pii: 19287
    PubMedGoogle Scholar
  • 11 Kumar A, Zarychanski R, Pinto R et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA 2009; 302: 1872-1879
    CrossrefPubMedGoogle Scholar
  • 12 Larcombe PJ, Moloney SE, Schmidt PA. Pandemic (H1N1) 2009: A clinical spectrum in the general paediatric population. Arch Dis Child 2009; 96: 96-98
    PubMedGoogle Scholar
  • 13 Panning M, Eickmann M, Landt O et al. Detection of influenza A(H1N1)v virus by real-time RT-PCR. Euro Surveill 2009; 14 pii: 19329
    PubMedGoogle Scholar
  • 14 Pierce M, Kurinczuk JJ, Spark P et al. Perinatal outcomes after maternal 2009/H1N1 infection: national cohort study. BMJ 2011; 342: d3214 DOI: 10.1136/bmj.d3214.
    CrossrefPubMedGoogle Scholar
  • 15 Saleeby E, Chapman J, Morse J et al. H1N1 influenza in pregnancy: cause for concern. Obstet Gynecol 2009; 114: 885-891
    CrossrefPubMedGoogle Scholar
  • 16 Steinhoff MC, Omer SB, Roy E et al. Influenza immunization in pregnancy–antibody responses in mothers and infants. N Engl J Med. 2010; 362: 1644-1646
    CrossrefPubMedGoogle Scholar
  • 17 Vaillant L, Ruche GL, Tarantola A et al. Epidemic intelligence team at In VS. Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009. Euro Surveill 2009; 14 pii: 19309
    PubMedGoogle Scholar
  • 18 Zaman K, Roy E, Arifeen SE et al. Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med. 2008; 359: 1555-1564
    CrossrefPubMedGoogle Scholar
  • 19 Zenciroglu A, Kundak AA, Aydin M et al. Swine influenza A (H1N1) virus infection in infants. Eur J Pediatr 2011; 170: 333-338
    CrossrefPubMedGoogle Scholar