Characteristics And Outcomes Of Children Admitted To Paediatric Intensive Care Units With Life Threatening Pertussis Infection In Great Britain 2023-2024

OBJECTIVES
Describe clinical characteristics, treatment and outcomes of children treated for life-
threatening Pertussis in paediatric intensive care units during the 2023-2024 outbreak in Great
Britain.
DESIGN
National multi-centre audit.
SETTING
All Paediatric Intensive Care Units (PICUs) in Great Britain.
PATIENTS
Between November 2023 and June 2024, 54 children with proven diagnosis of Bordetella
Pertussis as the primary reason for intensive care admission requiring invasive ventilation.
INTERVENTIONS
None
MAIN OUTCOME MEASURES
Mortality on PICU, length of stay and number of invasive ventilation days.
RESULTS
Median admission age 43 days, with peak blood White Cell Count (WCC) from 6x109/L to
149x109/L. 23% of infants’ mothers were vaccinated during pregnancy (national average 59%). Mortality was 11/54 (20%), with 10 in infants < 3 months. The survivor with the highest WCCpeaked at 82x109/L prior to exchange transfusion (XT), and the highest peak WCC in a survivorwithout XT was 71x109/L. Eighteen patients underwent 27 XTs for leucoreduction, initiated atmedian peak WCC of 54x109/L (range 32-148). All who died had XT planned, with ninecompleting. None with a peak WCC of <51x109/L died, although 4 patients underwent XTs. Inpatients with rising WCC, survivors’ rise rate was lower than those who died (0.23x109/L/h vs1.4x109/L/h).CONCLUSIONSIn children invasively ventilated due to Bordetella pertussis, higher peak WCC, rapid WCC rise,and a primary admission reason other than apnoeas are associated with mortality. Exchangetransfusions can be avoided in WCC <50x109/L.