title: Characteristics of Bordetella pertussis infection among infantsand children admitted to paediatric intensive care units in Greece: A multicentre, 11-year study.
abstract: OBJECTIVE
  To describe children with pertussis who required intensive care.
  
  
  METHODS
  This is a retrospective analysis of pertussis admissions to all (six) national intensive care units in Greece from 2003 to 2013.
  
  
  RESULTS
  A total of 31 children were included, 28 of whom were younger than 12 months old. Cough was the most prominent symptom, being present in 27 of 31 (87%) patients, and on admission, only 7 (22.6%) satisfied the case definition. Mechanical ventilation was initiated in 13 (42%) patients. Six patients died because of respiratory failure (two) or multi-organ system failure (four). The patients who died had significantly higher white blood cell counts (WBC) (77 800-31 600, P = 0.031) and neutrophils (29 016-12 795, P = 0021) than those who survived and lower minimum values of serum sodium (125-133, P = 0002). They also had a longer duration of hospitalisation prior to their paediatric intensive care unit admission (6-1 days, P = 0022). Three patients were diagnosed with pulmonary hypertension, and only one of them survived. Age, gender and immunisation status did not differ between survivors and non-survivors. Two patients received exchange blood transfusion, and survival benefit was not apparent.
  
  
  CONCLUSIONS
  Young infants are at risk of severe pertussis, resulting in serious complications or death. Elevated WBC and low serum sodium are associated with higher mortality. Despite advances in life support and treatment of organ failure in childhood critical illness, pertussis still has substantial mortality.
authors.affiliation: 2nd Department of Pediatrics, University of Athens, P & A Kuriakou Children's Hospital, Athens, Greece.|Pediatric Intensive Care Unit, Aghia Sofia Children's Hospital, Athens, Greece.
authors.forename: Maria S
authors.initials: MS
authors.lastname: Kazantzi
authors.affiliation: Pediatric Intensive Care Unit, P & A Kuriakou Children's Hospital, Athens, Greece.
authors.forename: Anargyroula
authors.initials: A
authors.lastname: Prezerakou
authors.affiliation: Pediatric Intensive Care Unit, Hippokrateion Hospital, Thessaloniki, Greece.
authors.forename: Serafeia N
authors.initials: SN
authors.lastname: Kalamitsou
authors.affiliation: Pediatric Intensive Care Unit, University Hospital of Crete, Heraklion, Greece.
authors.forename: Stavroula
authors.initials: S
authors.lastname: Ilia
authors.affiliation: Pediatric Intensive Care Unit, Aghia Sofia Children's Hospital, Athens, Greece.
authors.forename: Panagiotis K
authors.initials: PK
authors.lastname: Kalabalikis
authors.affiliation: Pediatric Intensive Care Unit, P & A Kuriakou Children's Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Papadatos
authors.affiliation: Pediatric Intensive Care Unit, Hippokrateion Hospital, Thessaloniki, Greece.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Sdougka
authors.affiliation: Pediatric Intensive Care Unit, University Hospital of Crete, Heraklion, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Briassoulis
authors.affiliation: 2nd Department of Pediatrics, University of Athens, P & A Kuriakou Children's Hospital, Athens, Greece.
authors.forename: Maria N
authors.initials: MN
authors.lastname: Tsolia
mesh_terms: D001886:Bordetella pertussis / Q000302:isolation & purification*; D003422:Critical Care / Q000379:methods; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D008485:Medical Audit; D012189:Retrospective Studies; D014917:Whooping Cough / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*
keywords: hyperleukocytosis; intensive care; outcome; pertussis; pulmonary hypertension