Clinical Features Of Pertussis Of Infants Aged 0-3 Months

Objective :To study the clinical features and current diagnosis and treatment of whooping cough in infants aged 0-3 months.Methods :The clinical data of 123 cases of whooping cough aged 0-3months between January 2015 and December 2017 in the Children's Hospital of Chongqing Medical University were collected.The epidemiology and clinical manifestations,ancillary examinations and diagnosis and treatment were retrospectively analyzed.Results:General information: The ratio of males and females is approximately(1.12:1);cases in 2015 accounted for 42.3%(52/123),cases in 2016 accounting for 32.5%(40/123)and cases in 2017 accounted for25.2%(31/123).The disease occured without a concentrated time distribution.62.6%(77/123)of Children were from cities,37.4%(46/123)of children were from rural areas;the newborns accounted for 14.7%(18/123).Hospital stay: The average length of hospital stay was 10±6.0 days,which the shortest is 3 days,the longest is 41 days,and the median is 8days.Clinical manifestations: Paroxysmal cough accounted for 56.9%(70/123);Face redness after cough accounted for 65%(80/123);Showed a high pitched whoop after cough accounted for 20.3%(25/123);Becoming cyanotic when coughing accounted for 45.5%(56/123);Vomiting after a coughing spell accounted for 26%(32/123);Baby foam accounted for32.5%(40/123);Vomiting milk accounted for 43.1%(53/123);Choking milk accounted for 38.2%(47/123),Polypnea accounted for 53.7%(66/123);30.9%(38/123)of them wheezed;4.1%(5/123)had apnea;Only9.8%(12/123)had a fever.Laboratory examination: The average Leukocyte level was 15.62±7.94*10^9/L,the lymphocyte ratio was 0.66±0.15,and the platelet level was 490±168*10^9/L.42.3%(52/123)of them showed mild aminotransferase abnormalities.29.3%(36/123)of them had mild myocardial marker abnormalities;3.3%(4/123)of them had hypoproteinemia.Etiological detection: The pertussis without concurrent infection accounted for 31.1%(38/122),52.5%(64/123)of them combined with one additional pathogen;14.8%(18/122)of them combined two additional pathogens;1.6%(2/123)of them combined three additional of pathogens.Imaging examination: There were 98 cases have chest imaging examinations,the positive rate was 54.1%(53/98).and pneumonia accounted for 49.0%(48/98);Pulmonary interstitial change accounted for8.2%(8/98);Pulmonary atelectasis accounted for 5.1%(5/98);Pulmonary consolidation accounted for 7.1%(7/98);Pleural changes accounted for4.1%(4/98);Pleural effusions accounted for 1.0%(1/98).Treatment: The average course of treatment of macrolide antibiotics before discharge from hospital was 1.4±0.8.Adjuvant treatment as follows: bronchodilators accounted for 76.5%(94/123),ambroxol accounted for 93.5%(115/123),and pulmicort accounted for 84.6%(104/123);vitamin k1 accounted for 48.0%(59/123);cyproheptadine accounted for 29.3%(36/123);theophyllinum accounted for 35.8%(44/123);magnesium sulfate accounted for 10.6%(13/123);intravenous immune globulin accounted for 7.3%(9/123)and intravenous glucocorticoid accounted for 8.1%(10/123);6.5%(8/123)of the them used a breathing machine.Prognosis: Among the 123 cases,98.38%(121/123)of the children had a good prognosis;1.62%of them(2/123)had a poor prognosis.Conclusion: The proportion of pertussis children aged 0-3 months from all affected children in Chongqing showed a decreasing trend year by year.More than half of children showed paroxysmal cough,there were more atypical clinical manifestations like becoming cyanotic when coughing,baby foam,vomiting milk,choking milk,polypnea and apnea.The virus concurrent infection about pertussis in this age was mostly infected with RSV,so it is necessary to exclude pertussis when RSV ispositive.The incidence of severe pertussis in 0-3 months is significantly higher than that in the whole age group.Face redness after cough,becoming cyanotic when coughing or polypnea,elevated leukocytes,positive of lung auscultation,pneumonia in imaging examination,and pulmonary atelectasis or consolidation in imaging examination were risk factors for severe pertussis;Elevated leukocytes and pulmonary atelectasis or consolidation in imaging examination were independent risk factors for severe pertussis.