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Risk factors for severe pertussis in children and the application of exchange transfusion
Qihong Chen1,2,3, Lihua Lin1,2,3, Shuping Xiong1,2,3
1Department of Pediatrics, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
Insights
Severe pertussis in children is predicted by younger age, lack of DTaP vaccination, shortness of breath, and high white blood cell (WBC) counts. Exchange transfusion effectively treats severe cases with pulmonary hypertension.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Pertussis, or whooping cough, remains a significant public health concern, particularly in infants and young children.
- Vaccination, primarily through the DTaP (diphtheria, tetanus, and acellular pertussis) vaccine, is the cornerstone of prevention.
- Identifying risk factors for severe disease is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To identify key risk factors associated with severe pertussis in pediatric patients.
- To evaluate the effectiveness of exchange transfusion as a therapeutic intervention for severe pertussis complications.
Main Methods:
- A retrospective analysis of pediatric pertussis cases, comparing mild and severe presentations.
- Utilized hospital data including demographics, clinical symptoms, laboratory findings, echocardiography, and complications.
- Employed Receiver Operating Characteristic (ROC) analysis to determine predictors of severe pertussis.
Main Results:
- Severe pertussis cases presented with earlier onset, spasmodic cough, shortness of breath, and rales.
- Key risk factors identified include lack of DTaP vaccination, younger age, shortness of breath, and elevated white blood cell (WBC) counts (WBC > 27.93 × 10^9/L).
- Exchange transfusion was effective in normalizing pulmonary hypertension and improving outcomes in patients with rising WBC counts and respiratory distress.
Conclusions:
- Younger age, unvaccinated status (no DTaP), shortness of breath, and high WBC counts are significant predictors of severe pertussis.
- A WBC count greater than 27.93 × 10^9/L serves as a robust biomarker for predicting disease severity.
- Exchange transfusion is a beneficial intervention for severe pertussis cases complicated by pulmonary hypertension and significantly elevated WBC counts.
Objective:
To identify risk factors for severe pertussis and assess the efficacy of exchange transfusion in children.
Methods:
We analyzed pediatric pertussis cases, comparing mild and severe presentations using hospital data on demographics, symptoms, lab findings, echocardiography, and complications, and employed ROC analysis to determine severe pertussis risk factors.
Results:
Our study analyzed 119 mild and 64 severe pertussis cases, with severe cases characterized by earlier onset, spasmodic cough, shortness of breath, and rales. Risk factors for severity included lack of DTaP vaccination and pulmonary hypertension. Severe cases also showed higher WBC and lymphocyte counts and more mixed infections. Logistic regression identified shortness of breath, no DTaP, younger age, and high WBC as severity predictors (P < 0.05). ROC analysis predicted severity with age < 3.68 months and WBC > 27.93 × 109/L (AUC = 0.606, 0.725; P < 0.05). Exchange transfusion in patients with rising WBC and shortness of breath normalized pulmonary hypertension and led to recovery.
Conclusion:
Clinicians should closely monitor unvaccinated children with shortness of breath, onset before 3.68 months, and WBC > 27.93 × 109/L for severe pertussis risk. Exchange transfusion is advised for those with WBC > 40 × 109/L and pulmonary hypertension, showing significant therapeutic benefit.
Impact:
This study delineates four key predictors of severe pertussis in children: younger age, lack of DTaP vaccination, shortness of breath, and elevated white blood cell (WBC) counts. We establish WBC > 27.93 × 109/L as a robust quantitative biomarker for severity prediction (AUC = 0.725), providing clinicians with an objective threshold to prioritize intensive monitoring and intervention. Exchange transfusion demonstrates efficacy in reducing WBC levels and resolving pulmonary hypertension in critical cases. These findings reinforce the imperative of DTaP vaccination to prevent severe disease and inform evidence-based management protocols.
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