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Specific characteristics identified for infants at highest risk for pertussis
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For infants too young to receive pertussis vaccine, early identification of those at higher risk may allow more rapid implementation of interventions.
Erin L. Murray, PhD, of the California Department of Public Health, and colleagues retrospectively reviewed data for 31 patients aged younger than 90 days with pertussis who were admitted to five different pediatric ICUs to attempt to identify factors associated with death and pulmonary hypertension.
Thirty-one infants were admitted to a participating pediatric ICU between September 2009 and June 2011; eight infants had more severe infections; six infants had pulmonary hypertension; and four infants died.
The researchers found no significant differences in demographics between infants with more severe vs. less severe pertussis infection. In addition, no differences were found in the number of days from cough onset to dates of first medical care; hospitalization; pediatric ICU admission; first pertussis test; or macrolide antibiotic initiation, according to the findings published in a recent issue of the Journal of the Pediatric Infectious Diseases Society.
However, the infants with more severe infections had white blood cell (WBC) counts that exceeded 30,000 cells/mm3, heart rates that exceeded 170 beats per minute and respiratory rates that exceeded 70 breaths per minute more rapidly after cough onset than the 23 infants with less severe illness.
“Our data suggest that a predictor of more severe Bordetella pertussis disease in young infants is an elevated and rapidly rising WBC count, making early and serial WBC count determinations critical to the evaluation of all infants with suspected or proven pertussis,” the study researchers wrote. “Furthermore, close monitoring of heart and respiratory rates is imperative because these were demonstrated to correlate with more severe disease progression.”
The researchers concluded that the study results highlight the importance of aggressive pediatric ICU care, besides early consideration of exchange transfusion, for the management of infants at high risk for severe pertussis.
Disclosure: Murray reports no relevant financial disclosures.
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