Akçay Nihal, Tosun Demet, Bingöl İlyas, Bingöl İbrahim, Çıtak Agop, Bayraktar Süleyman, Menentoğlu Mehmet Emin, Şevketoğlu Esra, Talip Mey, Umman Serin Nazlı, Bilgül Ceren, Koçoğlu Barlas Ülkem, Telhan Leyla, Şahin Ebru, İnceköy Girgin Feyza, Kılınç Mehmet Arda, Bursal Burcu, Baydemir Canan
Department of Pediatric Intensive Care Unit, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, 34093, Turkey.
Department of Pediatric Intensive Care Unit, Acıbadem Atakent Hospital, Acıbadem University, Istanbul, Turkey.
Eur J Pediatr. 2025 Jan 15;184(2):138. doi: 10.1007/s00431-025-05978-0.
This study aims to evaluate the clinical course of critical pertussis illness to the pediatric intensive care unit in Istanbul. The study was conducted as a multicenter, retrospective study between January 1, 2023, and December 31, 2023. Cases with positive polymerase chain reaction testing for Bordetella pertussis of nasopharyngeal swab samples within the first 24 h of pediatric intensive care unit admission were recorded. We divided the patients into exchange blood transfusion group and non-exchange blood transfusion group, comparing related factors and clinical characteristics among each group. A total of 50 children with severe pertussis were enrolled in the study, including 29 males (58%), with a median age of 9.14 weeks (range, 7.29-15.3 weeks). The mortality rate for severe pertussis was 8%. Exchange blood transfusion was performed in eight patients (16%). There were no significant differences between patients who received exchange blood transfusion and those who did not in terms of age, male gender, gestational age, birth weight, comorbidities, presenting symptoms, duration of cough, prior antibiotic use, vaccination status, coinfections, PICU length of stay, or mortality (p > 0.05). Children who underwent exchange blood transfusion had significantly higher white blood cell (WBC) counts, lymphocyte counts, neutrophil counts, and C-reactive protein (CRP) levels compared to those who did not receive the procedure (p < 0.05). Pulmonary hypertension was observed in 50% of the children who received exchange blood transfusion, while it was present in only 11.8% of those who did not undergo the procedure (p < 0.05). Additionally, patients who received exchange blood transfusion had higher incidences of respiratory failure, cardiac failure or arrest, inotrope requirement, and mechanical ventilation compared to those who did not receive the transfusion (p < 0.05).
Pertussis can lead to severe complications and mortality in critically ill infants. Most severe pertussis occurred in young, unimmunized infants. Children admitted with pertussis with high CRP level, high WBC and lymphocyte, and cardiac and respiratory failure can need exchange blood transfusion.
• Pertussis is a highly contagious respiratory infection caused by Bordetella pertussis, which primarily affects infants. Despite vaccination efforts, pertussis remains a significant cause of morbidity and mortality in infants, particularly those too young to be fully vaccinated.
• In pertussis, exchange blood transfusion may be considered in cases of severe pulmonary hypertension or cardiogenic shock, as indicated by echocardiographic findings, in conjunction with leukocytosis observed on laboratory tests.
本研究旨在评估伊斯坦布尔儿科重症监护病房中重症百日咳疾病的临床病程。该研究作为一项多中心回顾性研究，于2023年1月1日至2023年12月31日进行。记录儿科重症监护病房入院后首24小时内鼻咽拭子样本百日咳博德特氏菌聚合酶链反应检测呈阳性的病例。我们将患者分为换血组和非换血组，比较每组的相关因素和临床特征。共有50例重症百日咳患儿纳入研究，其中男性29例（58%），中位年龄为9.14周（范围7.29 - 15.3周）。重症百日咳的死亡率为8%。8例患者（16%）接受了换血治疗。接受换血治疗的患者与未接受换血治疗的患者在年龄、男性性别、胎龄、出生体重、合并症、出现的症状、咳嗽持续时间、既往抗生素使用情况、疫苗接种状况、合并感染、儿科重症监护病房住院时间或死亡率方面无显著差异（p＞0.05）。与未接受该治疗的患者相比，接受换血治疗的儿童白细胞（WBC）计数、淋巴细胞计数、中性粒细胞计数和C反应蛋白（CRP）水平显著更高（p＜0.05）。接受换血治疗的儿童中有50%观察到肺动脉高压，而未接受该治疗的儿童中仅11.8%出现肺动脉高压（p＜0.05）。此外，与未接受换血治疗的患者相比，接受换血治疗的患者呼吸衰竭、心力衰竭或心脏骤停、需要使用血管活性药物以及机械通气的发生率更高（p＜0.05）。
百日咳可导致重症婴儿出现严重并发症和死亡。大多数重症百日咳发生在未免疫的幼儿中。因百日咳入院且CRP水平高、白细胞和淋巴细胞计数高以及出现心脏和呼吸衰竭的儿童可能需要换血治疗。
• 百日咳是由百日咳博德特氏菌引起的一种高度传染性呼吸道感染，主要影响婴儿。尽管进行了疫苗接种，但百日咳仍然是婴儿发病和死亡的重要原因，尤其是那些太小而无法完全接种疫苗的婴儿。
• 在百日咳中，对于超声心动图检查结果显示的严重肺动脉高压或心源性休克病例，结合实验室检查中观察到的白细胞增多情况，可考虑进行换血治疗。
