9 mo old grand daughter has the flu. Tamiflu concerns

[darla09]

Hello to all the wonderful pediatric nurses. I am an adult medicine nurse ( Internal medicine) but we have a family illlnes that is causing this "Nana" to worry. The scenario: Sunday my grand daughter stayed the afternoon with her other Grandma. The grandma was symptom free but Monday morning she awakened with fever and cough. The grandma was swabbed and came back positive for influenza. A second person (an adult -Aunt) who was visiting on Sunday also developed flu symptoms on Tuesday and she swabbed positive. Today wed. my 9 month old grand duaghter started running a fever ( 101.3) and non productive cough. She saw her pediatrician who gave her Tamiflu. I am concerned about side effects of Tamiflu and I am worried about the flu. Of course I have researched this but I value a "nurse opinion" and so I am coming here for information as well. In your experience, what is the course of this illness and what do you think of Tamiflu for babies ?

Thank you so much for your expertise.

[NotReady4PrimeTime, RN]

Since you're asking for an opinion and not medical advice, I'll answer this. our unit hasn't yet seen an infant with H1N1, but we do see a small number of babies with influenza A and B each year in the PICU. I can't recall any of them being given oseltamivir (Tamiflu); in Canada it was not approved for use in children under 1 year old until this summer. But having said that, I routinely give a wide variety of drugs that are not approved for use in children or which have limited information regarding use in children. We give them either because there is no alternative or because the risk/benefit arguments are reasonable. I'm talking about things like bosentan, milrinone, amiodarone, sildenafil, nesritide, epoprostenol and others. I know we will be giving oseltamivir to babies this winter and I think it's reasonable, knowing how sick babies can get with influenza.

As to the course of influenza in infants, they aren't the sickest babies I've seen with respiratory illnesses; those have had intercurrent RSV and adenovirus with cavitating pneumonias who ended up dying after weeks on ECLS. Babies that end up in PICU with influenza develop an intercurrent bacterial pneumonia and their conditions tend to deteriorate very rapidly. They often need prolonged mechanical ventilation. But as I said, we only see a small number of cases a year, and those kids typically have an underlying chronic illness such as congenital heart disease or chronic lung disease of prematurity.

You will recognize signs of worsening respiratory distress in your grandbaby and get her to hospital promptly, but I suspect she'll recover without needing an admission.

[darla09]

Thank you this is exactly the kind of "nurse sharing" I want to hear. Working the Internal medicine field I am more adept at teaching patients about diabetes and giving insulin. My grand daughter has no underlying health problems, my son and his fmaily live a few hours away but they are intelligent and we have talked about being aware of respiratory issues.

Thank you again.. Bless you for the work you do!!

[NotReady4PrimeTime, RN]

You're welcome.