Analysis of clinical features of neonatal and infantile pertussis / 国际儿科学杂志

ABSTRACT

Objective:To analyse the clinical features and prognosis of pertussis in neonates and infants.Methods:The clinical data of neonates and infants with pertussis hospitalized in Children′s Hospital of Soochow University from September 2021 to September 2022 were retrospectively analyzed and grouped in terms of age, the severity of the disease, and whether a mixed infection, respectively.Results:A total of 40 infants with pertussis were analyzed.All cases showed improvement and were discharged after receiving active anti-infective treatment.In the neonatal group, higher rates of apnea and hyponatremia were observed compared to the non-neonatal group(all P<0.05).Additionally, peripheral blood leukocyte counts[20.9(15.0, 28.7)×10 9/L vs.16.6(11.3, 21.2)×10 9/L], neutrophil counts[4.6(3.7, 7.9)×10 9/L vs.3.2(2.1, 5.3)×10 9/L], γ-glutamyltransferase levels[78.0( 50.2, 109.4)U/L vs.22.5(15.1, 38.9)U/L], duration of hospitalization[21.5(16.8, 25.0)d vs.11.5(9.0, 19.8)d], and duration of oxygen use[7.0(0, 21.0)d vs.0(0, 2.3)d]were higher in the neonatal group than in the non-neonatal group(all P<0.05).However, the IgA level[0.02(0.02, 0.04)g/L vs.0.05(0.03, 0.09)g/L]was significantly lower in the neonatal group than in the non-neonatal group( P<0.05).In the severe group, the proportion of onset age of less than 3 months, fever, wheezing, shortness of breath, cyanosis after rough cough, apnea, decreased heart rate, wet rales on lung auscultation, respiratory failure, cardiac insufficiency, hyponatremia, CRP>8 mg/L, spotty/patchy shadows in the lungs, as well as the use of gammaglobulin, cardioactive drug and invasive ventilation, were higher than those in the non-severe group(all P<0.05).Furthermore, peripheral blood leukocyte counts[21.0(15.4, 37.4)×10 9/L vs.17.5(11.8, 21.2)×10 9/L], neutrophil counts[5.6(4.0, 10.7)×10 9/L vs.3.2(2.3, 4.6)×10 9/L], neutrophil to lymphocyte ratio[(0.6±0.4) vs.( 0.3±0.2)], systemic immune-inflammation index[237.5(109.5, 424.9) vs.135.9(75.4, 190.5)], γ-glutamyltransferase level[53.2(31.6, 87.4)U/L vs.29.5(15.2, 65.0)U/L], duration of oxygen use[18.0(12.8, 22.5)d vs.0(0, 0)d], and duration of hospitalization[24.5(21.8, 31.2)d vs.12.0(9.0, 16.8)d]were higher in the severe group than those in the non-severe group(all P<0.05).However, the IgA level[0.03(0.02, 0.04)g/L vs.0.05(0.03, 0.09)g/L]was significantly lower in the severe group than in the non-severe group( P<0.05).The mixed infection group had a longer duration of hospitalization and a higher proportion of fever than the single infection group(all P<0.05). Conclusion:Early detection of infantile pertussis can be challenging.Neonates with pertussis tend to experience severe symptoms, such as apnea, hyponatremia, elevated white blood cell count, and longer duration of oxygen use.Symptoms such as fever, wheezing, shortness of breath, decreased heart rate, wet lung rales, and spotty/patchy shadows in the lungs, as well as early elevated CRP, neutrophil to lymphocyte ratio, systemic immune-inflammation index, and decreased IgA levels are indicators of disease exacerbation.In mixed infections group, there is a higher proportion of fever.