• John T Berger, Joseph A Carcillo, Thomas P Shanley, David L Wessel, Amy Clark, Richard Holubkov, Kathleen L Meert, Christopher J L Newth, Robert A Berg, Sabrina Heidemann, Rick Harrison, Murray Pollack, Heidi Dalton, Eric Harvill, Alexia Karanikas, Teresa Liu, Jeri S Burr, Allan Doctor, J Michael Dean, Tammara L Jenkins, Carol E Nicholson, and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN).
• Department of Pediatrics, Children's National Medical Center Washington, DC, USA. jberger@cnmc.org
• Pediatr Crit Care Me. 2013 May 1; 14 (4): 356-65.

ObjectivePertussis persists in the United States despite high immunization rates. This report characterizes the presentation and acute course of critical pertussis by quantifying demographic data, laboratory findings, clinical complications, and critical care therapies among children requiring admission to the PICU.DesignProspective cohort study.SettingEight PICUs comprising the Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network and 17 additional PICUs across the United States.PatientsEligible patients had laboratory confirmation of pertussis infection, were younger than 18 years old, and died in the PICU or were admitted to the PICU for at least 24 hours between June 2008 and August 2011.InterventionsNone.Measurements And Main ResultsA total of 127 patients were identified. Median age was 49 days, and 105 (83%) patients were less than 3 months old. Fifty-five (43%) patients required mechanical ventilation and 12 patients (9.4%) died during initial hospitalization. Pulmonary hypertension was found in 16 patients (12.5%) and was present in 75% of patients who died, compared with 6% of survivors (p < 0.001). Median WBC was significantly higher in those requiring mechanical ventilation (p < 0.001), those with pulmonary hypertension (p < 0.001), and nonsurvivors (p < 0.001). Age, sex, and immunization status did not differ between survivors and nonsurvivors. Fourteen patients received leukoreduction therapy (exchange transfusion [12], leukopheresis [1], or both [1]). Survival benefit was not apparent.ConclusionsPulmonary hypertension may be associated with mortality in pertussis critical illness. Elevated WBC is associated with the need for mechanical ventilation, pulmonary hypertension, and mortality risk. Research is indicated to elucidate how pulmonary hypertension, immune responsiveness, and elevated WBC contribute to morbidity and mortality and whether leukoreduction might be efficacious.

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