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Pertussis: severe clinical presentation in pediatric intensive care and its relation to outcome

Poongundran Namachivayam1, Kazuyoshi Shimizu, Warwick Butt

  • 1Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia. siva.namachivayam@rch.org.au

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|April 10, 2007
PubMed

Insights

Infants with pertussis (whooping cough) presenting with apnea had 100% survival in the pediatric intensive care unit. However, pneumonia presentation and circulatory support were linked to poor outcomes in pertussis patients.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Pertussis, commonly known as whooping cough, is a highly contagious respiratory infection caused by Bordetella pertussis.
  • Vaccination is the primary method of prevention, yet outbreaks continue to occur, particularly affecting unvaccinated infants.
  • Severe cases of pertussis in infants can lead to serious complications requiring intensive care.

Purpose of the Study:

  • To analyze the institutional experience in managing infants and children with pertussis admitted to the pediatric intensive care unit over a 20-year period.
  • To investigate the relationship between the clinical presentation of pertussis and patient outcomes.

Main Methods:

  • A retrospective review of medical records and radiology reports was conducted for patients diagnosed with pertussis.
  • Data were collected from the pediatric intensive care unit database of a tertiary pediatric hospital in Melbourne, Australia, between January 1985 and December 2004.
  • Patient demographics, reasons for admission, treatment, and outcomes were analyzed.

Main Results:

  • A total of 49 patients (median age, 6 weeks) were admitted 55 times to the pediatric intensive care unit.
  • The primary reasons for admission were apnea (63%), pneumonia (18%), and seizures (10%).
  • None of the admitted infants had completed their primary immunization course; 94% had not received any pertussis vaccine dose. Infants with pneumonia presented earlier, had longer intensive care stays, higher white cell counts, lower Pao2, and higher mortality rates. Six of seven infants requiring circulatory support died, including all four treated with extracorporeal membrane oxygenation. All seven deaths occurred in infants presenting with pneumonia.

Conclusions:

  • Infants with pertussis presenting with apnea (with or without cough paroxysms) had a 100% survival rate when managed in the pediatric intensive care unit.
  • Pneumonia as the primary reason for admission and the need for circulatory support were associated with a significantly poor prognosis.
  • Further research into the molecular mechanisms of Bordetella pertussis and its interaction with the human host is needed to develop novel therapeutic strategies.
Abstract

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