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Clinical characteristics and prognosis of exchange transfusion in infants with severe pertussis
Pingping Liu1, Zhenghui Xiao2, Jiaotian Huang1
1Department of Emergency & Key Laboratory of Pediatric Emergency Medicine of Hunan Province, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital), Changsha, Hunan, China.
Insights
Exchange transfusion (ET) therapy improves outcomes for infants with severe pertussis. Higher white blood cell counts and organ dysfunction indicate a poorer prognosis, necessitating early intervention for severe pertussis treatment.
Area of Science:
- Pediatrics
- Neonatology
- Infectious Diseases
Background:
- Severe pertussis poses a significant threat to infants.
- Exchange transfusion (ET) is a critical care intervention.
- Understanding ET's role in severe pertussis is crucial for clinical management.
Purpose of the Study:
- To evaluate the efficacy and clinical significance of exchange transfusion (ET) in infants with severe pertussis.
- To establish a basis for the diagnosis and treatment of severe pertussis.
- To identify prognostic indicators in infants undergoing ET for severe pertussis.
Main Methods:
- Retrospective study of 45 infants with severe pertussis receiving ET.
- Comparison of clinical manifestations and biochemical indicators between surviving and mortality groups.
- Statistical analysis using chi-square, t-test, and Mann-Whitney U tests.
Main Results:
- Mortality rate was 22.2% (10/45) among infants receiving ET.
- Higher incidences of oliguria, bradycardia, and pleural effusion in the mortality group.
- Elevated WBC, NE, CRP, PCT, NT-BNP, Cr, LDH, CK, and MYO levels in the mortality group.
- Poorer blood gas parameters (lower PH, PO2; higher PCO2, Lac) in the mortality group.
- Increased rates of pulmonary hypertension, heart failure, AKI, and encephalopathy in the mortality group.
Conclusions:
- Exchange transfusion (ET) is vital for improving prognosis in severe pertussis.
- Peak WBC count and organ dysfunction (cardiac, renal, neurological) are associated with poorer outcomes.
- Early intervention and aggressive treatment are essential for managing severe pertussis in infants.
Background:
To explore the efficacy and clinical significance of exchange transfusion (ET) therapy in infants with severe pertussis, and provide a basis for the diagnosis and treatment of severe pertussis.
Methods:
45 infants diagnosed with severe pertussis and receiving ET treatment in the intensive care unit of Hunan Children's Hospital from January 1, 2019 to June 30, 2024 were selected as the study subjects. According to the prognosis, they were divided into surviving group (n = 35) and mortality group (n = 10), and the clinical manifestations and biochemical indicators of the two groups were compared. The comparison between groups of count data was conducted using the chi square test. The t-test is used to compare between groups whose measurement data conforms to a normal distribution; The Mann Whitney U test is used to compare between groups that do not follow a normal distribution.
Results:
The mortality of 45 infants with severe pertussis who received ET treatment was 22.2% (10/45). The incidences of oliguria, bradycardia, and pleural effusion in the mortality group were higher than those in the surviving group, and the differences were statistically significant (P < 0.05). The white blood cells (WBC) and neutrophils (NE) in mortality group were significantly higher than those in surviving group before ET treatment. After 24 h and 48 h of ET treatment, the WBC and NE in mortality group were still higher than those in surviving group (P < 0.05). There were no statistically significant differences in WBC and NE between the two groups 72 h after ET treatment (P > 0.05). The levels of C-reactive protein (CRP), procalcitonin (PCT), N-terminal B-type natriuretic peptide precursor (NT-BNP), creatinine (Cr), lactate dehydrogenase (LDH), creatine kinase (CK), and myoglobin (MYO) in mortality group were all higher than those in surviving group before ET therapy (P < 0.05). The PH and PO2 levels in the blood gas analysis of mortality group were lower than those of surviving group before ET treatment, while PCO2 and lactate (Lac) levels were higher than those of mortality group (P < 0.05). The incidences of pulmonary hypertension, heart failure, cardiogenic shock, acute kidney injury, and pertussis encephalopathy in mortality group were higher than those in surviving group, and the differences were statistically significant (P < 0.05). The usage rates of hormones and vasoactive drugs in mortality group were higher than those in surviving group (P < 0.05).
Conclusions:
ET is an important treatment for improving the prognosis of infants with severe pertussis. Infants with severe pertussis who undergo ET have a higher peak WBC count, and those with concomitant pulmonary arterial hypertension, cardiac, renal, neurological dysfunction have a poorer prognosis. Early intervention and active treatment are necessary.
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