Straney Lahn, Schibler Andreas, Ganeshalingham Anusha, Alexander Janet, Festa Marino, Slater Anthony, MacLaren Graeme, Schlapbach Luregn J
1Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 2Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia. 3Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia. 4Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand. 5Australian and New Zealand Paediatric Intensive Care Registry, CORE, Royal Children's Hospital Brisbane, Herston, QLD, Australia. 6Paediatric Intensive Care Unit, Children's Hospital Westmead, Sydney, NSW, Australia. 7Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia. 8Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. 9Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore. 10Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Pediatr Crit Care Med. 2016 Aug;17(8):735-42. doi: 10.1097/PCC.0000000000000851.
Despite World Health Organization endorsed immunization schedules, Bordetella pertussis continues to cause severe infections, predominantly in infants. There is a lack of data on the frequency and outcome of severe pertussis infections in infants requiring ICU admission. We aimed to describe admission rates, severity, mortality, and costs of pertussis infections in critically ill infants.
Binational observational multicenter study.
Ten PICUs and 19 general ICUs in Australia and New Zealand contributing to the Australian and New Zealand Paediatric Intensive Care Registry.
Infants below 1 year of age, requiring intensive care due to pertussis infection in Australia and New Zealand between 2002 and 2014.
During the study period, 416 of 42,958 (1.0%) infants admitted to the ICU were diagnosed with pertussis. The estimated population-based ICU admission rate due to pertussis ranged from 2.1/100,000 infants to 18.6/100,000 infants. Admission rates were the highest among infants less than 60 days old (p < 0.0001). Two hundred six infants (49.5%) required mechanical ventilation, including 20 (4.8%) treated with high-frequency oscillatory ventilation, 16 (3.8%) with inhaled nitric oxide, and 7 (1.7%) with extracorporeal membrane oxygenation. Twenty of the 416 children (4.8%) died. The need for mechanical ventilation, high-frequency oscillatory ventilation, nitric oxide, and extracorporeal membrane oxygenation were significantly associated with mortality (p < 0.01). Direct severe pertussis-related hospitalization costs were in excess of USD$1,000,000 per year.
Pertussis continues to cause significant morbidity and mortality in infants, in particular during the first months of life. Improved strategies are required to reduce the significant healthcare costs and disease burden of this vaccine-preventable disease.
尽管世界卫生组织认可免疫接种计划，但百日咳博德特氏菌仍继续导致严重感染，主要发生在婴儿中。对于需要入住重症监护病房（ICU）的婴儿，严重百日咳感染的频率和转归缺乏相关数据。我们旨在描述重症婴儿百日咳感染的入院率、严重程度、死亡率及费用。
双边观察性多中心研究。
澳大利亚和新西兰的10个儿科重症监护病房（PICU）及19个综合重症监护病房，这些病房参与了澳大利亚和新西兰儿科重症监护登记系统。
2002年至2014年间，澳大利亚和新西兰因百日咳感染而需要重症监护的1岁以下婴儿。
在研究期间，42958名入住ICU的婴儿中有416名（1.0%）被诊断为百日咳。基于人群的百日咳导致的ICU入院率估计为每10万名婴儿中有2.1例至18.6例。60日龄以下婴儿的入院率最高（p<0.0001）。206名婴儿（49.5%）需要机械通气，其中20名（4.8%）接受高频振荡通气治疗，16名（3.8%）接受吸入一氧化氮治疗，7名（1.7%）接受体外膜肺氧合治疗。416名儿童中有20名（4.8%）死亡。机械通气、高频振荡通气、一氧化氮及体外膜肺氧合的需求与死亡率显著相关（p<0.01）。与百日咳直接相关的严重住院费用每年超过100万美元。
百日咳继续在婴儿中导致显著的发病和死亡，尤其是在生命的最初几个月。需要改进策略以降低这种疫苗可预防疾病带来的巨大医疗费用和疾病负担。
