In the Journals

Revised pertussis protocols needed for treatment of young infants

James Cherry
James D. Cherry

Updated strategies for the treatment of severe pertussis in young infants, including serial white blood cell counts and treating all presumptive cases with azithromycin, have been suggested by researchers in a study published in The Pediatric Infectious Disease Journal.

“Over the last decade, members of our extended group have investigated many aspects of pertussis in young infants,” James D. Cherry, MD, MSc, from the David Geffen School of Medicine at UCLA, and colleagues wrote. “Specifically, we have studied the pathology, pathogenesis, risk factors for death, clinical characteristics and various approaches relating to treatment.”

To better understand the features and treatment of pertussis in young infants, the researchers collected data on cases reported to the California Department of Public Health. All children included in the study were 120 days or younger and admitted to a pediatric intensive care unit between October 1, 2013, and April 25, 2015. One hundred medical records were reviewed by pediatric infectious disease physicians at 11 centers (67 patients) and the Department of Public Health Department (33 patients).

Cherry and colleagues specifically collected data regarding patient demographics; pertussis vaccination history for the mother and infant; illness history and characteristics; chest x-ray study and echocardiography findings; serial white blood cell counts, serial pulse and respiratory rates; and various treatment modalities, including exchange blood transfusion. Diagnoses were confirmed through polymerase chain reaction or cultures.

Five of the 100 children with reported pertussis died within the treatment period, and their white blood cell counts were significantly higher than those who survived. The average age of those who died because of pertussis at onset was 23 days. Of the 100 total patients, 34% were intubated, 18% were given inotropic and/or vasoactive support and 22% were administered steroids. Additionally, 4% received extracorporal membrane oxygenation and 3% had exchange blood transfusion.

The researchers suggest performing serial white blood cell counts, treating all presumptive cases of pertussis with azithromycin, evaluating for pulmonary hypertension, intubating and administering oxygen for apneic episodes, and administering inotropic/vasoactive agents for cardiogenic shock.

“In this study, only two of the 96 infant pertussis cases with a recorded temperature had a temperature of 38° C or higher,” Cherry and colleagues wrote. “The lack of fever is important because it may lead caregivers to initially think the illness is a common upper respiratory infection, leading to a delay in the correct diagnosis and treatment of this potentially serious or fatal illness.” – by Katherine Bortz

Disclosure: Cherry consulted for GSK on April 4, 2016. The remaining authors report no conflict of interest.
James Cherry
James D. Cherry

Updated strategies for the treatment of severe pertussis in young infants, including serial white blood cell counts and treating all presumptive cases with azithromycin, have been suggested by researchers in a study published in The Pediatric Infectious Disease Journal.

“Over the last decade, members of our extended group have investigated many aspects of pertussis in young infants,” James D. Cherry, MD, MSc, from the David Geffen School of Medicine at UCLA, and colleagues wrote. “Specifically, we have studied the pathology, pathogenesis, risk factors for death, clinical characteristics and various approaches relating to treatment.”

To better understand the features and treatment of pertussis in young infants, the researchers collected data on cases reported to the California Department of Public Health. All children included in the study were 120 days or younger and admitted to a pediatric intensive care unit between October 1, 2013, and April 25, 2015. One hundred medical records were reviewed by pediatric infectious disease physicians at 11 centers (67 patients) and the Department of Public Health Department (33 patients).

Cherry and colleagues specifically collected data regarding patient demographics; pertussis vaccination history for the mother and infant; illness history and characteristics; chest x-ray study and echocardiography findings; serial white blood cell counts, serial pulse and respiratory rates; and various treatment modalities, including exchange blood transfusion. Diagnoses were confirmed through polymerase chain reaction or cultures.

Five of the 100 children with reported pertussis died within the treatment period, and their white blood cell counts were significantly higher than those who survived. The average age of those who died because of pertussis at onset was 23 days. Of the 100 total patients, 34% were intubated, 18% were given inotropic and/or vasoactive support and 22% were administered steroids. Additionally, 4% received extracorporal membrane oxygenation and 3% had exchange blood transfusion.

The researchers suggest performing serial white blood cell counts, treating all presumptive cases of pertussis with azithromycin, evaluating for pulmonary hypertension, intubating and administering oxygen for apneic episodes, and administering inotropic/vasoactive agents for cardiogenic shock.

“In this study, only two of the 96 infant pertussis cases with a recorded temperature had a temperature of 38° C or higher,” Cherry and colleagues wrote. “The lack of fever is important because it may lead caregivers to initially think the illness is a common upper respiratory infection, leading to a delay in the correct diagnosis and treatment of this potentially serious or fatal illness.” – by Katherine Bortz

Disclosure: Cherry consulted for GSK on April 4, 2016. The remaining authors report no conflict of interest.