Related Experiment Video
Updated: Feb 26, 2026
Evaluation of Host-Pathogen Responses and Vaccine Efficacy in Mice
Published on: February 22, 2019
An Observational Study of Severe Pertussis in 100 Infants ≤120 Days of Age
Insights
Severe pertussis in infants under 120 days old can be fatal. Higher white blood cell counts indicate a worse prognosis, guiding updated treatment strategies for this serious respiratory illness.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Pertussis (whooping cough) in infants under 120 days is a severe, afebrile cough illness with high mortality.
- Infants present unique challenges in diagnosis and management due to atypical symptoms.
Purpose of the Study:
- To evaluate clinical characteristics and outcomes of severe pertussis in young infants.
- To identify factors associated with mortality in this population.
- To inform updated management strategies for severe pertussis in infants.
Main Methods:
- Retrospective evaluation of pertussis cases in infants ≤120 days old admitted to a California pediatric intensive care unit (PICU) from October 2013 to April 2015.
- Analysis of clinical data, including white blood cell counts, interventions, and outcomes.
Main Results:
- Five deaths occurred among 100 infants with pertussis in the PICU.
- Fatal cases had significantly higher white blood cell counts compared to non-fatal cases.
- Common interventions included intubation (34%), inotropic/vasoactive support (18%), and steroids (22%).
Conclusions:
- Updated management strategies for severe infant pertussis are suggested, emphasizing serial white blood cell counts and prompt azithromycin treatment.
- Recommendations include evaluating for pulmonary hypertension, intubation for apnea, and inotropic agents for shock.
- Avoidance of steroids and nitric oxide is advised; criteria for exchange blood transfusion for leukocytosis are proposed.
Background:
Pertussis in young infants is a unique, severe, afebrile, cough illness that is frequently fatal.
Methods:
All pertussis cases ≤120 days of age admitted to a pediatric intensive care unit in California between October 1, 2013, and April 25, 2015, were evaluated.
Results:
Of 100 pertussis patients ≤120 days of age admitted to pediatric intensive care unit, there were 5 deaths. The white blood cell counts in the fatal cases were significantly higher than in the nonfatal cases. Thirty-four percent of patients were intubated, 18% received inotropic and/or vasoactive support, 22% received steroid, 4% received extracorporal membrane oxygenation, and 3% underwent exchange blood transfusion. The median age at the time of illness onset in the patients who died was 23 days.
Conclusions:
These data, as well as data from previous California studies, suggest updated strategies for the management of severe pertussis. These include perform serial white blood cell counts, treat all presumptive cases with azithromycin, evaluate for pulmonary hypertension, intubate and administer oxygen for apneic episodes and administer inotropic/vasoactive agents for cardiogenic shock. Do not administer steroids or nitric oxide. Criteria for exchange blood transfusion therapy for leukocytosis with lymphocytosis are suggested.
