title: Critical pertussis illness in children: a multicenter prospective cohort study.
abstract: 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.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  None.
  
  
  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.
authors.affiliation: Department of Pediatrics, Children's National Medical Center Washington, DC, USA. jberger@cnmc.org
authors.forename: John T
authors.initials: JT
authors.lastname: Berger
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Carcillo
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Shanley
authors.forename: David L
authors.initials: DL
authors.lastname: Wessel
authors.forename: Amy
authors.initials: A
authors.lastname: Clark
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Meert
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Newth
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Sabrina
authors.initials: S
authors.lastname: Heidemann
authors.forename: Rick
authors.initials: R
authors.lastname: Harrison
authors.forename: Murray
authors.initials: M
authors.lastname: Pollack
authors.forename: Heidi
authors.initials: H
authors.lastname: Dalton
authors.forename: Eric
authors.initials: E
authors.lastname: Harvill
authors.forename: Alexia
authors.initials: A
authors.lastname: Karanikas
authors.forename: Teresa
authors.initials: T
authors.lastname: Liu
authors.forename: Jeri S
authors.initials: JS
authors.lastname: Burr
authors.forename: Allan
authors.initials: A
authors.lastname: Doctor
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.forename: Tammara L
authors.initials: TL
authors.lastname: Jenkins
authors.forename: Carol E
authors.initials: CE
authors.lastname: Nicholson
mesh_terms: D001919:Bradycardia / Q000382:microbiology; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000382:microbiology* / Q000401:mortality; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007937:Leukapheresis; D007958:Leukocyte Count; D008297:Male; D011014:Pneumonia / Q000382:microbiology; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D012121:Respiration, Artificial; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014917:Whooping Cough / Q000097:blood / Q000150:complications* / Q000401:mortality* / Q000628:therapy
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