Neuraminidase Inhibitors Improve Survival in Kids With Flu

Troy Brown, RN

November 25, 2013

Neuraminidase inhibitor (NAI) drugs improved survival of children with influenza when they were given the drugs within the first 48 hours of illness, according to an analysis published online November 25 in Pediatrics.

"Our results suggest that prompt NAI therapy in children with influenza virus infection who are hospitalized in an ICU may improve survival, including in those most severely ill who require mechanical ventilation," write Janice K. Louie, MD, MPH, a public health medical officer at the California Department of Public Health in Richmond, and colleagues.

Currently available NAI drugs include enteral oseltamivir phosphate, inhaled zanamivir, and the investigational intravenous formulations of peramivir and zanamivir, the authors note.

The researchers reviewed the medical records for 784 children aged 0 to 18 years who were hospitalized in ICUs during the 2009 H1N1 pandemic (591 cases from April 3, 2009, through August 31, 2010) and postpandemic (193 cases from September 1, 2010, through September 30, 2012) periods. NAIs were given to 90% (532) of patients during the pandemic period compared with only 63% (121; P < .0001) of patients during the postpandemic period.

Of the 653 children who received NAIs, 38 (6%) died compared with 11 (8%) of the 131 children who did not receive NAIs (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.34 - 1.36).

In a bivariate analysis that was stratified on mechanical ventilation, NAI treatment was significantly associated with lower mortality (OR, 0.38; 95% CI, 0.17 - 0.87), but not in a similar analysis stratified on pneumonia (OR, 0.64; 95% CI, 0.29 - 1.38).

In multivariate analyses, the researchers adjusted for significant variables that were associated with fatality in the univariate analysis, including the presence of an Advisory Committee for Immunization Practices comorbid condition, diagnosis of pneumonia, and requirement of mechanical ventilation.

The estimated risk for death was decreased in NAI-treated children (OR, 0.36; 95% CI, 0.16 - 0.84). Children who received NAIs within 48 hours of becoming ill were significantly more likely to survive (P = .04).

In addition, those who received treatment sooner after becoming ill were less likely to die. "There was a significant difference between the median time from onset of symptoms to treatment of nonfatal cases (median 3 days, range 0–33 days) compared with fatal cases (5 days, range 0–29 days; P = .004)," the authors write.

"[P]rompt initiation of NAIs seems prudent in a critical care setting where the likelihood of severe morbidity and mortality outweighs concern for side effects. This message needs additional emphasis given that in this study, more than one-third of critically ill children with influenza did not receive antiviral treatment in the postpandemic period," the authors conclude.

The California Department of Public Health provided financial support for all phases of this study. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online November 25, 2013.

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