Pertussis in young infants is a unique, severe, afebrile, cough illness that is frequently fatal.
All pertussis cases ≤120 days of age admitted to a pediatric intensive care unit in California between October 1, 2013, and April 25, 2015, were evaluated.
Of 100 pertussis patients ≤120 days of age admitted to pediatric intensive care unit, there were 5 deaths. The white blood cell counts in the fatal cases were significantly higher than in the nonfatal cases. Thirty-four percent of patients were intubated, 18% received inotropic and/or vasoactive support, 22% received steroid, 4% received extracorporal membrane oxygenation, and 3% underwent exchange blood transfusion. The median age at the time of illness onset in the patients who died was 23 days.
These data, as well as data from previous California studies, suggest updated strategies for the management of severe pertussis. These include perform serial white blood cell counts, treat all presumptive cases with azithromycin, evaluate for pulmonary hypertension, intubate and administer oxygen for apneic episodes and administer inotropic/vasoactive agents for cardiogenic shock. Do not administer steroids or nitric oxide. Criteria for exchange blood transfusion therapy for leukocytosis with lymphocytosis are suggested.
From the *David Geffen School of Medicine, Department of Pediatrics at UCLA, Los Angeles, California; †California Department of Public Health, Immunization Branch, Richmond, California; ‡Children’s Hospital of Orange County, Department of Pediatrics, Orange, California; §University of California San Diego and Rady Children’s Hospital San Diego, Department of Pediatrics, San Diego, California; ¶Children’s Hospital of Los Angeles, Department of Pediatrics, Los Angeles, California; ‖Loma Linda University Children’s Hospital, Department of Pediatrics, Loma Linda, California; **Miller Children’s & Women’s Hospital Long Beach, Department of Pediatrics, Long Beach, California; ††University of California, Davis, Department of Pediatrics, Davis, California; ‡‡UCSF Benioff Children’s Hospital Department of Pediatrics, Oakland, Oakland, California; §§Stanford University School of Medicine, Department of Pediatrics, Stanford, California; ¶¶UCSF Benioff Children’s Hospital, Department of Pediatrics, San Francisco, California; and ‖‖Kaiser Permanente Fontana Medical Center, Department of Pediatrics, Fontana, California.
Accepted for publication April 29, 2017.
J.D.C. consulted for GSK on April 4, 2016. The other authors have no conflicts of interest to disclose.
Address for correspondence: James D. Cherry, MD, MSc, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, MDCC 22-442, Los Angeles, CA 90095. E-mail: firstname.lastname@example.org.