VI ) Guidelines for management of Pediatric patients of H1N1 influenza A

The standard A, B, C classification should be used for classifying the patients of pandemic influenza.
Patients who have high grade fever, respiratory distress, not feeding/poorly feeding, sick, those with cyanosis, excessive vomiting or convulsions, or an other danger signs need to be admitted and monitored. There should be lower threshold for admitting patients in the pediatric age group.
Avoid use of aspirin for treating fever. Paracetamol to be used for treating fever.
All patients need to be treated with Oseltamivir for minimum 5 das (up to 10 days if no clinical improvement).
Broad spectrum parenteral antimicrobials should be used for treatment.
Any clinical deterioration should prompt PICU (Pediatric ICU) admission.
Oxygen should be used in all patients with respiratory distress or when clinically indicated.
Ventilation Strategy : High PEEP, low tidal volume and lowest required FiO2 should be used. Hypercapnia can be tolerated (permissive hypercapnia).
For Pediatric ARDS patients:

Use Low tidal volume (6-8 ml/kg)
Minimal tolerable inspired O2 with high PEEP to achieve Pa)2 55- 60mm Hg and max tolerable PaCO2 50-60 mm Hg with arterial pH ≥7.25 & absence of metabolic acidosis

Careful attention needs to be paid to the fluid and electrolyte balance.
Shock (if any) needs to be treated with fluid therapy and ionotropes.
Monitoring required: Clinical parameters, vital signs, chest radiography, pulse oximetry and capnography

Table 1.Antiviral medication dosing recommendations for treatment or chemoprophylaxis of 2009 H1N1 infection. (Table extracted from IDSA guidelines for seasonal influenza)
Agent, group		Treatment (5 days)		Chemoprophylaxis (10 days)
Oseltamivir
Adults		75-mg capsule twice per day		75-mg capsule once per day
Children ≥ 12 months	15 kg or less	60 mg per day divided into 2 doses		30 mg once per day
	16-23 kg	90 mg per day divided into 2 doses		45 mg once per day
	24-40 kg	120 mg per day divided into 2 doses		60 mg once per day
	>40 kg	150 mg per day divided into 2 doses		75 mg once per day
Zanamivir
Adults	Two 5-mg inhalations (10 mg total) twice per day		Two 5-mg inhalations (10 mg total) once per day
Children	Two 5-mg inhalations (10 mg total) twice per day (age, 7 years or older)		Two 5-mg inhalations (10 mg total) once per day (age, 5 years or older)

Treatment and Chemoprophylaxis for Children younger than 1 Year of Age

Table 2. Dosing recommendations for antiviral treatment or chemoprophylaxis of children younger than 1 year using oseltamivir.
Age	Recommended treatment dose for 5 days	Recommended prophylaxis dose for 10 days
Younger than 3 months	12 mg twice daily	Not recommended unless situation judged critical due to limited data on use in this age group
3-5 months	20 mg twice daily	20 mg once daily
6-11 months	25 mg twice daily	25 mg once daily

References:

recommendations.htm