Namachivayam Poongundran, Shimizu Kazuyoshi, Butt Warwick
Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
Pediatr Crit Care Med. 2007 May;8(3):207-11. doi: 10.1097/01.PCC.0000265499.50592.37.
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.
Pediatric intensive care unit in a university-affiliated tertiary pediatric hospital in Melbourne, Australia.
DESIGN/METHODS: Retrospective review of medical records and radiology reports of patients with a diagnosis of pertussis identified from the pediatric intensive care unit database.
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.
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.
描述我们机构在1985年1月至2004年12月这20年期间收治的百日咳婴幼儿及儿童的管理经验，并研究临床表现方式与预后之间的关系。
澳大利亚墨尔本一家大学附属三级儿科医院的儿科重症监护病房。
设计/方法：对从儿科重症监护病房数据库中识别出的百日咳诊断患者的病历和放射学报告进行回顾性分析。
共有49例患者（中位年龄6周；四分位间距4 - 8周）需要55次入住儿科重症监护病房。入院的主要原因是伴有或不伴有阵咳的呼吸暂停（63%）、肺炎（18%）和惊厥（10%）。所有婴儿均未完成基础免疫疗程，94%未接种过一剂百日咳疫苗。表现为肺炎的婴儿入院更早（p = 0.001），重症监护病房住院时间更长（p = 0.007），白细胞计数更高（p≤0.001），入院时动脉血氧分压更低（p = 0.020），死亡率更高。7例需要循环支持的婴儿中有6例死亡（包括所有4例接受体外膜肺氧合治疗的婴儿），所有死亡病例（n = 7）均发生在入院时患有肺炎的婴儿中。
在儿科重症监护病房接受治疗的以呼吸暂停（伴有或不伴有阵咳）为表现的百日咳患者存活率为100%。然而，以肺炎为主要入院原因且需要循环支持与极差的预后相关。对百日咳博德特菌的分子基础及其与人类宿主关系的更深入理解可能为未来治疗提供方法。
