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Critical Pertussis in the PICU: Multinational Study in the Gulf Cooperation Council Region, 2022-2024
Mohammad Alghounaim1, Naila A Shaheen2,3, Abdulrahman Aldaithan4,5
1Department of Pediatrics, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait.
Insights
Critical pertussis severely impacts young infants in the GCC, causing high morbidity and mortality. This study highlights significant variations in pediatric intensive care unit (PICU) management and underscores the need for standardized care protocols and improved prevention strategies.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Critical pertussis is a severe, life-threatening illness in infants, characterized by significant morbidity and mortality.
- The Gulf Cooperation Council (GCC) region faces challenges in managing pediatric critical pertussis.
Purpose of the Study:
- To describe the epidemiology of pediatric critical pertussis in the GCC.
- To outline the clinical features and management variability of critical pertussis in GCC pediatric intensive care units (PICUs).
Main Methods:
- A multinational retrospective cohort study was conducted between July 2022 and December 2024.
- Data were collected from 35 PICUs across six GCC countries.
- Included were 204 infants and children younger than 16 years with laboratory-confirmed pertussis.
Main Results:
- The median age of affected infants was 53 days, with most previously healthy.
- Respiratory distress and apnea were primary admission reasons; 49.5% experienced hyperleukocytosis.
- Mortality was 15.2%, with significant variations in management practices, including leukoreduction and respiratory support.
Conclusions:
- Critical pertussis poses a substantial threat to young infants in the GCC, with high rates of illness and death.
- Wide variations in clinical management highlight an urgent need for standardized care protocols.
- Strengthening prevention strategies, including vaccination, is crucial for reducing the burden of critical pertussis.
Objectives:
Critical pertussis is a life-threatening illness that predominantly affects young infants, with substantial morbidity and mortality. In this study, we aimed to describe the epidemiology, clinical features, and variability in management of pediatric critical pertussis in the Gulf Cooperation Council (GCC) region.
Design:
Multinational retrospective cohort study conducted between July 2022 and December 2024.
Setting:
Thirty-five PICUs in the six GCC countries.
Patients:
Children 16 years old or younger with laboratory-confirmed pertussis (by polymerase chain reaction or culture) admitted to a PICU.
Interventions:
None.
Measurements And Main Results:
A total of 204 cases of critical pertussis were identified. Median (interquartile range [IQR]) age was 53 days (IQR, 36.5-89 d). Most patients (91.2%) were healthy before PICU admission. Comorbidities included acyanotic congenital heart disease (3.9%) or respiratory disease (2.9%). Only 17.3% had received infant pertussis vaccination and 4.1% had mothers vaccinated during pregnancy. The median duration of hospital stay was 9 days (IQR, 6-16 d), and PICU stay was 5 days (IQR, 3-10 d). Hyperleukocytosis (> 30 × 10 9 /L) occurred in 49.5%. Respiratory distress (47.6%) and apnea (28.4%) were the main reasons for PICU admission. Management varied widely: leukoreduction was performed in 27.4%, with significant variation in practice across countries. Use of high-flow nasal cannula and mechanical also varied across the region. Extracorporeal membrane oxygenation was rarely used (1.5%). Echocardiography was obtained in nearly half of the cohort, and revealed pulmonary hypertension in 24 patients. Overall mortality was 15.2%, most commonly attributed to septic shock and respiratory failure.
Conclusions:
Critical pertussis predominantly affects young infants, with substantial morbidity, mortality, and wide variation in management practices. Our cohort from 2022 to 2024 highlights our GCC regional need for standardized care protocols and strengthened prevention.
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