Oseltamivir treatment and prophylaxis in a neonatal intensive care unit during a 2009 H1N1 influenza outbreak

Abstract

Objective: To evaluate safety of oseltamivir in neonates with significant comorbidities in a level-III neonatal intensive care unit during an outbreak of 2009 H1N1 influenza. Study Design: We performed a retrospective chart review of neonates who received oseltamivir for treatment and prophylaxis of influenza during the outbreak. Result: A total of 11 neonates received twice daily dosing and 21 neonates received once daily dosing (12 to 25 mg per dose) for treatment and prophylaxis of influenza, respectively. Age ranged from 2 days to 11.4 months (mean, 2.1 months). Corrected gestational age and weight at initiation of oseltamivir ranged from 32 to 86 weeks (mean, 41 weeks) and 775 to 8635 g (mean, 3074 g), respectively. All had complex underlying conditions. Oseltamivir was well tolerated. Neurologic adverse effects or mortality attributable to oseltamivir were not identified. Mild rash and gastrointestinal signs in four infants resolved without oseltamivir discontinuation. Three showed a transient rise in transaminases; all returned to baseline after completing therapy. Conclusion: Oseltamivir appears to be well tolerated in preterm and term neonates and infants with complex underlying conditions. More studies are needed to determine optimal dosing for treatment and prophylaxis in this vulnerable age group.

Prematurity and the burden of influenza and respiratory syncytial virus disease

“…Preliminary data suggest that oseltamivir is safe and well tolerated in the treatment of influenza infection in preterm infants, [69,70] and 1.0 mg/kg per dose twice daily produces oseltamivir carboxylate exposure similar to that in older children receiving 3.0 mg/kg per dose twice daily. [71] Nevertheless, an association with necrotizing enterocolitis has recently been reported.…”

Viral Infections in a Neonatal Intensive Care Unit

“…Since oseltamivir was never used before in this age group, special attention was paid to its eventual side effects, which did not occur as we previously reported [20]. The same was also reported in a recent study [21].…”

Influenza infection in infants aged <6 months during the H1N1‐09 pandemic: A hospital‐based case series

“…[34][35][36][37] Studies suggest that oseltamivir is well tolerated regardless of age and pre-existing illness. [38][39][40] Data regarding efficacy, safety and dosing for young infants are required. 41 Sixty-six percent of infants were treated with antibiotics despite only three having confirmed bacterial co-infections; however, antibiotic therapy is a standard part of clinical protocols for the management of febrile infants.…”