Lahn Straney1, Andreas Schibler, Anusha Ganeshalingham, Janet Alexander, Marino Festa, Anthony Slater, Graeme MacLaren, Luregn J Schlapbach. 1. 1Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 2Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia. 3Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia. 4Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand. 5Australian and New Zealand Paediatric Intensive Care Registry, CORE, Royal Children's Hospital Brisbane, Herston, QLD, Australia. 6Paediatric Intensive Care Unit, Children's Hospital Westmead, Sydney, NSW, Australia. 7Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia. 8Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. 9Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore. 10Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Abstract
OBJECTIVES: Despite World Health Organization endorsed immunization schedules, Bordetella pertussis continues to cause severe infections, predominantly in infants. There is a lack of data on the frequency and outcome of severe pertussis infections in infants requiring ICU admission. We aimed to describe admission rates, severity, mortality, and costs of pertussis infections in critically ill infants. DESIGN: Binational observational multicenter study. SETTING: Ten PICUs and 19 general ICUs in Australia and New Zealand contributing to the Australian and New Zealand Paediatric Intensive Care Registry. PATIENTS: Infants below 1 year of age, requiring intensive care due to pertussis infection in Australia and New Zealand between 2002 and 2014. MEASUREMENTS AND MAIN RESULTS: During the study period, 416 of 42,958 (1.0%) infants admitted to the ICU were diagnosed with pertussis. The estimated population-based ICU admission rate due to pertussis ranged from 2.1/100,000 infants to 18.6/100,000 infants. Admission rates were the highest among infants less than 60 days old (p < 0.0001). Two hundred six infants (49.5%) required mechanical ventilation, including 20 (4.8%) treated with high-frequency oscillatory ventilation, 16 (3.8%) with inhaled nitric oxide, and 7 (1.7%) with extracorporeal membrane oxygenation. Twenty of the 416 children (4.8%) died. The need for mechanical ventilation, high-frequency oscillatory ventilation, nitric oxide, and extracorporeal membrane oxygenation were significantly associated with mortality (p < 0.01). Direct severe pertussis-related hospitalization costs were in excess of USD$1,000,000 per year. CONCLUSIONS: Pertussis continues to cause significant morbidity and mortality in infants, in particular during the first months of life. Improved strategies are required to reduce the significant healthcare costs and disease burden of this vaccine-preventable disease.
OBJECTIVES: Despite World Health Organization endorsed immunization schedules, Bordetella pertussis continues to cause severe infections, predominantly in infants. There is a lack of data on the frequency and outcome of severe pertussis infections in infants requiring ICU admission. We aimed to describe admission rates, severity, mortality, and costs of pertussis infections in critically ill infants. DESIGN: Binational observational multicenter study. SETTING: Ten PICUs and 19 general ICUs in Australia and New Zealand contributing to the Australian and New Zealand Paediatric Intensive Care Registry. PATIENTS: Infants below 1 year of age, requiring intensive care due to pertussis infection in Australia and New Zealand between 2002 and 2014. MEASUREMENTS AND MAIN RESULTS: During the study period, 416 of 42,958 (1.0%) infants admitted to the ICU were diagnosed with pertussis. The estimated population-based ICU admission rate due to pertussis ranged from 2.1/100,000 infants to 18.6/100,000 infants. Admission rates were the highest among infants less than 60 days old (p < 0.0001). Two hundred six infants (49.5%) required mechanical ventilation, including 20 (4.8%) treated with high-frequency oscillatory ventilation, 16 (3.8%) with inhaled nitric oxide, and 7 (1.7%) with extracorporeal membrane oxygenation. Twenty of the 416 children (4.8%) died. The need for mechanical ventilation, high-frequency oscillatory ventilation, nitric oxide, and extracorporeal membrane oxygenation were significantly associated with mortality (p < 0.01). Direct severe pertussis-related hospitalization costs were in excess of USD$1,000,000 per year. CONCLUSIONS: Pertussis continues to cause significant morbidity and mortality in infants, in particular during the first months of life. Improved strategies are required to reduce the significant healthcare costs and disease burden of this vaccine-preventable disease.
Authors: Fernando Palvo; Alexandre Todorovic Fabro; Maria Célia Cervi; Davi Casale Aragon; Fernando Silva Ramalho; Ana Paula de Carvalho Panzeri Carlotti Journal: Medicine (Baltimore) Date: 2017-12 Impact factor: 1.817