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Critical Pertussis Illness in Children: A Multicenter Prospective Cohort Study*

Berger, John T. MD1; Carcillo, Joseph A. MD2; Shanley, Thomas P. MD3; Wessel, David L. MD1; Clark, Amy MS4; Holubkov, Richard PhD4; Meert, Kathleen L. MD5; Newth, Christopher J. L. MD, FRCPC6; Berg, Robert A. MD7; Heidemann, Sabrina MD5; Harrison, Rick MD8; Pollack, Murray MD9; Dalton, Heidi MD9; Harvill, Eric PhD10; Karanikas, Alexia PhD(c)10; Liu, Teresa MPH4; Burr, Jeri S. MS, RN-BC, CCRC4; Doctor, Allan MD11; Dean, J. Michael MD, MBA4; Jenkins, Tammara L. MSN, RN12; Nicholson, Carol E. MD, MS12

Pediatric Critical Care Medicine: May 2013 - Volume 14 - Issue 4 - p 356–365
doi: 10.1097/PCC.0b013e31828a70fe
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Objective: Pertussis persists in the United States despite high immunization rates. This report characterizes the presentation and acute course of critical pertussis by quantifying demographic data, laboratory findings, clinical complications, and critical care therapies among children requiring admission to the PICU.

Design: Prospective cohort study.

Setting: Eight PICUs comprising the Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network and 17 additional PICUs across the United States.

Patients: Eligible patients had laboratory confirmation of pertussis infection, were younger than 18 years old, and died in the PICU or were admitted to the PICU for at least 24 hours between June 2008 and August 2011.

Interventions: None.

Measurements and Main Results: A total of 127 patients were identified. Median age was 49 days, and 105 (83%) patients were less than 3 months old. Fifty-five (43%) patients required mechanical ventilation and 12 patients (9.4%) died during initial hospitalization. Pulmonary hypertension was found in 16 patients (12.5%) and was present in 75% of patients who died, compared with 6% of survivors (p < 0.001). Median WBC was significantly higher in those requiring mechanical ventilation (p < 0.001), those with pulmonary hypertension (p < 0.001), and nonsurvivors (p < 0.001). Age, sex, and immunization status did not differ between survivors and nonsurvivors. Fourteen patients received leukoreduction therapy (exchange transfusion [12], leukopheresis [1], or both [1]). Survival benefit was not apparent.

Conclusions: Pulmonary hypertension may be associated with mortality in pertussis critical illness. Elevated WBC is associated with the need for mechanical ventilation, pulmonary hypertension, and mortality risk. Research is indicated to elucidate how pulmonary hypertension, immune responsiveness, and elevated WBC contribute to morbidity and mortality and whether leukoreduction might be efficacious.

1Department of Pediatrics, Children’s National Medical Center Washington, DC.

2Department of Critical Care Medicine, Children’s Hospital of Pittsburgh Pittsburgh, PA.

3Department of Pediatrics, C.S. Mott Children’s Hospital Ann Arbor, MI.

4Department of Pediatrics, University of Utah Salt Lake City, UT.

5Department of Pediatrics, Children’s Hospital of Michigan Detroit, MI.

6Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles Los Angeles, CA.

7Department of Pediatrics, Children’s Hospital of Philadelphia Philadelphia, PA.

8Department of Pediatrics, Mattel Children’s Hospital UCLA Los Angeles, CA.

9Department of Child Health, Phoenix Children’s Hospital Phoenix, AZ.

10Pennsylvania State University University Park, PA.

11Departments of Pediatrics and Biochemistry, St. Louis Children’s Hospital St. Louis, MO.

12Department of Pediatrics, Eunice Kennedy Shriver National Institute of Child Health and Human Bethesda, MD.

*See also p. 434.

Supported, in part, by cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Department of Health and Human Services (U10HD050096, U10HD049981, U10HD049983, U10HD050012, U10HD063108, U10HD063106, U10HD063114, U10HD049945, U10HD050009, and U01HD049934), and the National Vaccine Program Office at the United States Department of Health and Human Services.

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The authors have disclosed that they do not have any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies