Severe Pneumonia Caused by 2009 Pandemic Influenza A (H1N1) Virus in Children and Corticosteroid Treatment

Yu Rak Sohn; Jong Hee Kim; Sang Hyuk Ma; Kyung Yil Lee; Jin Han Kang

doi:10.14776/kjpid.2011.18.2.193

Journal List > Korean J Pediatr Infect Dis > v.18(2) > 1096085

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Sohn, Kim, Ma, Lee, and Kang: Severe Pneumonia Caused by 2009 Pandemic Influenza A (H1N1) Virus in Children and Corticosteroid Treatment

Original Article

Korean Journal of Pediatric Infectious Diseases

Korean Journal of Pediatric Infectious Diseases 2011; 18(2): 193-200.

Published online: 31 December 2011

DOI: https://doi.org/10.14776/kjpid.2011.18.2.193

Severe Pneumonia Caused by 2009 Pandemic Influenza A (H1N1) Virus in Children and Corticosteroid Treatment

Yu Rak Sohn, M.D., Jong Hee Kim, M.D., Sang Hyuk Ma, M.D.^*, Kyung Yil Lee, M.D.^†, Jin Han Kang, M.D.^†

Department of Pediatrics, Daegu, Fatima Hospital, Daegu, Republic of Korea.

^*Department of Pediatrics, Changwon Fatima Hospital, Changwon, Republic of Korea.

^†Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Corresponding author (pedma@naver.com)

Received 1 October 2011 Revised 16 October 2011 Accepted 17 October 2011

Abstract

Purpose

The effect of corticosteroid on severe pneumonia caused by 2009 pandemic influenza (H1N1) A virus is controversial. This study was aimed to present the effects of early, short-term corticosteroid treatment for severe pneumonia with this virus infection.

Methods

A retrospective analysis was performed on severe pneumonia patients (37 patients) who had severe respiratory distress at presentation requiring oxygen therapy and received intravenous methylprednisolone (MP, 8-10 mg/kg, divided in 4 doses/day for 2-3 days) with oseltamivir. The clinical and laboratory characteristics of the patients were evaluated through the medical records and chest radiographic findings.

Results

The mean age and male-to-female ratio of the patients were 6.5±2.9 years of age, and 3.4:1 (male 29 patients), respectively. The 5-9 aged group was predominant among the age groups (25 patients, 67.6%). Duration of fever prior to admission was 1.4±0.6 days and dyspnea developed within 24 h after beginning of respiratory symptoms in all patients. All patients were previously healthy and received oseltamivir within 48 h. Thirteen patients (35.1%) developed dyspnea during oseltamivir treatment. Following MP infusion, all 37 patients including 13 progressive pneumonia patients during oseltamivir treatment showed an immediate halt in the progression of pneumonic infiltration with rapid clinical improvement. There were no side-effects following steroid use.

Conclusion

For severe pneumonia patients, early corticosteroid treatment halted clinical exacerbation, and possibly prevented progression to acute respiratory distress syndrome. Further controlled clinical studies are needed for the role of corticosteroids and antivirals on severely affected patients with influenza virus infections.

Keywords: H1N1 influenza virus, Corticosteroid, Pneumonia, Children

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