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

<p dir="ltr">OBJECTIVES<br>Describe clinical characteristics, treatment and outcomes of children treated for life-<br>threatening Pertussis in paediatric intensive care units during the 2023-2024 outbreak in Great<br>Britain.<br>DESIGN<br>National multi-centre audit.<br>SETTING<br>All Paediatric Intensive Care Units (PICUs) in Great Britain.<br>PATIENTS<br>Between November 2023 and June 2024, 54 children with proven diagnosis of Bordetella<br>Pertussis as the primary reason for intensive care admission requiring invasive ventilation.<br>INTERVENTIONS<br>None<br>MAIN OUTCOME MEASURES<br>Mortality on PICU, length of stay and number of invasive ventilation days.<br>RESULTS<br>Median admission age 43 days, with peak blood White Cell Count (WCC) from 6x109/L to<br>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.</p>