Clinical characteristics and prognosis of exchange transfusion in infants with severe pertussis.

Background: To explore the efficacy and clinical significance of exchange transfusion (ET) therapy in infants with severe pertussis, and provide a basis for the diagnosis and treatment of severe pertussis.

Methods: 45 infants diagnosed with severe pertussis and receiving ET treatment in the intensive care unit of Hunan Children's Hospital from January 1, 2019 to June 30, 2024 were selected as the study subjects. According to the prognosis, they were divided into surviving group (n = 35) and mortality group (n = 10), and the clinical manifestations and biochemical indicators of the two groups were compared. The comparison between groups of count data was conducted using the chi square test. The t-test is used to compare between groups whose measurement data conforms to a normal distribution; The Mann Whitney U test is used to compare between groups that do not follow a normal distribution.

Results: The mortality of 45 infants with severe pertussis who received ET treatment was 22.2% (10/45). The incidences of oliguria, bradycardia, and pleural effusion in the mortality group were higher than those in the surviving group, and the differences were statistically significant (P < 0.05). The white blood cells (WBC) and neutrophils (NE) in mortality group were significantly higher than those in surviving group before ET treatment. After 24 h and 48 h of ET treatment, the WBC and NE in mortality group were still higher than those in surviving group (P < 0.05). There were no statistically significant differences in WBC and NE between the two groups 72 h after ET treatment (P > 0.05). The levels of C-reactive protein (CRP), procalcitonin (PCT), N-terminal B-type natriuretic peptide precursor (NT-BNP), creatinine (Cr), lactate dehydrogenase (LDH), creatine kinase (CK), and myoglobin (MYO) in mortality group were all higher than those in surviving group before ET therapy (P < 0.05). The PH and PO₂ levels in the blood gas analysis of mortality group were lower than those of surviving group before ET treatment, while PCO₂ and lactate (Lac) levels were higher than those of mortality group (P < 0.05). The incidences of pulmonary hypertension, heart failure, cardiogenic shock, acute kidney injury, and pertussis encephalopathy in mortality group were higher than those in surviving group, and the differences were statistically significant (P < 0.05). The usage rates of hormones and vasoactive drugs in mortality group were higher than those in surviving group (P < 0.05).

Conclusions: ET is an important treatment for improving the prognosis of infants with severe pertussis. Infants with severe pertussis who undergo ET have a higher peak WBC count, and those with concomitant pulmonary arterial hypertension, cardiac, renal, neurological dysfunction have a poorer prognosis. Early intervention and active treatment are necessary.