Hu Yang, Zhuang Yan, Wu Yun-Qin, Xiao Zheng-Hui
Department of Critical Care Medicine, Children's Hospital of Xiangya School of Medicine, Central South University/Hunan Children's Hospital, Changsha 410007, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2024 Nov 15;26(11):1155-1161. doi: 10.7499/j.issn.1008-8830.2407018.
To investigate the efficacy and safety of exchange transfusion in neonates with severe pertussis.
A retrospective analysis was performed for the medical data of five neonates with severe pertussis who underwent exchange transfusion in the Department of Neonatology, Hunan Children's Hospital, from August 2019 to March 2024. The clinical characteristics of the patients were summarized, and the efficacy and adverse reactions of exchange transfusion were analyzed.
All five neonates had the symptoms of hypoxemia, recurrent apnea, and heart failure and required invasive mechanical ventilation. Two cases of pulmonary hypertension were observed, one of which was complicated by decompensated shock. Before exchange transfusion, the five children had a median leukocyte count of 82.60×10/L, a median absolute lymphocyte count of 28.20×10/L, and a median absolute neutrophil count of 43.10×10/L, and reexamination at 4 hours after exchange transfusion showed that these values decreased to 28.40×10/L, 7.60×10/L, and 15.40×10/L, respectively. The four children who underwent exchange transfusion in the early stage of cardiopulmonary failure showed varying degrees of improvement in oxygenation and a reduction in the partial pressure of carbon dioxide, and they were discharged after improvement; the one child who underwent exchange transfusion in the late stage of cardiopulmonary failure ultimately died. No child experienced severe adverse reactions related to exchange transfusion.
For neonates with severe pertussis, initiating exchange transfusion in the early stages of cardiopulmonary failure can effectively reduce leukocyte levels, potentially improve survival rates, and is relatively safe.
探讨换血疗法治疗重症百日咳新生儿的疗效及安全性。
回顾性分析2019年8月至2024年3月在湖南省儿童医院新生儿科接受换血治疗的5例重症百日咳新生儿的病历资料。总结患儿的临床特征，分析换血疗法的疗效及不良反应。
5例新生儿均有低氧血症、反复呼吸暂停及心力衰竭症状，均需有创机械通气。观察到2例肺动脉高压，其中1例并发失代偿性休克。换血前，5例患儿白细胞计数中位数为82.60×10⁹/L，绝对淋巴细胞计数中位数为28.20×10⁹/L，绝对中性粒细胞计数中位数为43.10×10⁹/L，换血后4小时复查显示这些值分别降至28.40×10⁹/L、7.60×10⁹/L和15.40×10⁹/L。4例在心肺功能衰竭早期接受换血治疗的患儿氧合情况有不同程度改善，二氧化碳分压降低，好转后出院；1例在心肺功能衰竭晚期接受换血治疗的患儿最终死亡。无患儿发生与换血相关的严重不良反应。
对于重症百日咳新生儿，在心肺功能衰竭早期启动换血疗法可有效降低白细胞水平，可能提高生存率，且相对安全。
