Pertussis requiring intensive care
- 22 March 2007
- journal article
- Published by BMJ in Archives of Disease in Childhood
- Vol. 92 (11), 970-975
- https://doi.org/10.1136/adc.2006.114082
Abstract
Objectives: To describe children with pertussis who require intensive care. Design, setting and patients: An audit in Auckland, New Zealand, of pertussis admissions to the national paediatric intensive care unit (PICU) from 1991 to 2003. Results: 72 children, 97% of whom were <12 months old. The annual number of cases increased with time (p = 0.04). Forty patients (56%) were coughing for less than 8 days before admission. Apnoea or paroxysmal cough was present in 33 (83%) of these children. Thirty five (49%) received assisted ventilation. Four died. 19% were readmitted to PICU. Those readmitted presented with more atypical disease and had a shorter first admission but longer total PICU admission (9 vs 5 days, p = 0.009). Of the 58 children from Auckland, nine either died (three) or had subsequent respiratory or neurodevelopmental problems (six). There was an increased risk (relative risk, 95% CI) of death or disability associated with having a co-morbidity (RR = 5.56, 1.50 to 8.15), an elevated lymphocyte count (RR = 5.75, 1.54 to 13.65), presenting with seizures/encephalopathy (4.87, 1.18 to 8.34) or shock (6.50, 1.89 to 8.94), having a PIM score of 1% or more (RR = 6.20, 1.22 to 21.72), any abnormal neurological signs (RR = 9.65, 3.32 to 15.23) or being readmitted to PICU (RR = 4.63, 1.44 to 8.82). Conclusions: Apnoea and paroxysmal cough are key symptoms of pertussis in those with shorter cough duration. Death or disability are frequent. Clinical factors define children at increased risk of these poor outcomes. Early discharge from PICU is associated with an increased risk of readmission and poor outcome.Keywords
This publication has 25 references indexed in Scilit:
- Hospitalisations due to pertussis in New Zealand in the pre‐immunisation and mass immunisation erasJournal of Paediatrics and Child Health, 2007
- Whooping cough in school age children with persistent cough: prospective cohort study in primary careBMJ, 2006
- Severe and unrecognised: pertussis in UK infantsArchives of Disease in Childhood, 2003
- Increase in deaths from pertussis among young infants in the United States in the 1990sThe Pediatric Infectious Disease Journal, 2003
- Immunogenicity of a Three-Component Acellular Pertussis Vaccine Administered at BirthPEDIATRICS, 2003
- Pertussis--United States, 1997-2000.2002
- Is leukocytosis a predictor of mortality in severe pertussis infection?Intensive Care Medicine, 2000
- Bordetella pertussis surveillance in England and Wales: 1995–7Epidemiology and Infection, 1999
- ECLS in pertussis: does it have a role?Intensive Care Medicine, 1998
- Pertussis Infection in Adults With Persistent CoughJAMA, 1995