Arch Dis Child. Published Online First: 4 July 2007. doi:10.1136/adc.2006.114082
Original articles |
Pertussis requiring intensive care
1 Starship Children's Hospital, Auckland District Health Board, New Zealand
2 Department of Paediatrics, University of Auckland, New Zealand
* To whom correspondence should be addressed. E-mail: cc.grant{at}auckland.ac.nz.
Accepted 27 June 2007
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% < 12 months old. The annual number of cases increased with time (p = 0.04). Forty (56%) were coughing for less than eight days before admission. Apnoea or paroxysmal cough were present in 33 (83%) of these children. 19% were readmitted to PICU. Those readmitted presented with more atypical disease, had a shorter first admission but longer total PICU admission (9 versus 5 days, p = 0.009). Thirty five (49%) received assisted ventilation. Four died. Of the 58 children from Auckland 9 either died (3), or had subsequent respiratory or neurodevelopmental problems (6). There was an increased risk (relative risk, 95% CI) of death or disability associated with having a co-morbidity (RR = 5.56, 1.50-8.15), an elevated lymphocyte count (RR = 5.75, 1.54-13.65), presenting with seizures/encephalopathy (4.87, 1.18-8.34 ) or shock (6.50, 1.89-8.94), having a PIM score of 1% or more (RR = 6.20, 1.22-21.72 ), any abnormal neurological signs (RR = 9.65, 3.32-15.23), or being readmitted to PICU (RR = 4.63, 1.44-8.82 ).
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: Intensive Care Units, Paediatric, infant, risk factors, whooping cough
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