Pertussis: severe clinical presentation in pediatric intensive care and its relation to outcome.
OBJECTIVE
To describe our institutional experience in the management of infants and children with pertussis admitted during a 20-yr period (January 1985 through December 2004) and also to study the relation between method of presentation and outcome.


METHODS
Pediatric intensive care unit in a university-affiliated tertiary pediatric hospital in Melbourne, Australia.


METHODS
Retrospective review of medical records and radiology reports of patients with a diagnosis of pertussis identified from the pediatric intensive care unit database.


RESULTS
A total of 49 patients (median age, 6 wks; interquartile range, 4-8 wks) required 55 admission episodes to the pediatric intensive care unit. Main reasons for admission were apnea with or without cough paroxysms (63%), pneumonia (18%), and seizures (10%). None of the infants had completed the primary course of immunization, and 94% had not received a single dose of pertussis vaccine. Infants presenting with pneumonia presented earlier (p = .001), had longer intensive care stay (p = .007), higher white cell count (p < or = .001), lower Pao2 at admission (p = .020), and higher mortality. Six infants out of seven needing circulatory support died (including all four treated with extracorporeal membrane oxygenation), and all deaths (n = 7) occurred in infants who had pneumonia at presentation.


CONCLUSIONS
Patients with pertussis, presenting as apnea (with or without cough paroxysms), treated in the pediatric intensive care unit had 100% survival. However, pneumonia as the main reason for admission and the need for circulatory support is associated with a very poor outcome. A deeper understanding of the molecular basis of Bordetella pertussis and its relation to the human host might offer means for future therapies.
Namachivayam
Poongundran
P
Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia. siva.namachivayam@rch.org.au
Shimizu
Kazuyoshi
K
Butt
Warwick
W
D002675:Child, Preschool; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D017063:Outcome Assessment, Health Care; D010567:Pertussis Vaccine; D018410:Pneumonia, Bacterial / Q000209:etiology; D012189:Retrospective Studies; D014917:Whooping Cough / Q000150:complications / Q000175:diagnosis / Q000628:therapy
D010567:Pertussis Vaccine