[Application of exchange transfusion in neonates with severe pertussis and hyperleukocytosis]

To investigate the efficacy and safety of exchange transfusion in neonates with severe pertussis.

A retrospective analysis was performed for the medical data of five neonates with severe pertussis who underwent exchange transfusion in the Department of Neonatology, Hunan Children's Hospital, from August 2019 to March 2024. The clinical characteristics of the patients were summarized, and the efficacy and adverse reactions of exchange transfusion were analyzed.

All five neonates had the symptoms of hypoxemia, recurrent apnea, and heart failure and required invasive mechanical ventilation. Two cases of pulmonary hypertension were observed, one of which was complicated by decompensated shock. Before exchange transfusion, the five children had a median leukocyte count of 82.60×10⁹/L, a median absolute lymphocyte count of 28.20×10⁹/L, and a median absolute neutrophil count of 43.10×10⁹/L, and reexamination at 4 hours after exchange transfusion showed that these values decreased to 28.40×10⁹/L, 7.60×10⁹/L, and 15.40×10⁹/L, respectively. The four children who underwent exchange transfusion in the early stage of cardiopulmonary failure showed varying degrees of improvement in oxygenation and a reduction in the partial pressure of carbon dioxide, and they were discharged after improvement; the one child who underwent exchange transfusion in the late stage of cardiopulmonary failure ultimately died. No child experienced severe adverse reactions related to exchange transfusion.

For neonates with severe pertussis, initiating exchange transfusion in the early stages of cardiopulmonary failure can effectively reduce leukocyte levels, potentially improve survival rates, and is relatively safe.