| Objective :To study the clinical characteristics,diagnosis and treatment status of neonatal pertussis,outcomes and the influencing factors of disease course.Methods: The medical records of 40 neonatal pertussis were summarized and analyzed to explore the factors affecting the course of neonatal pertussis.Results: Epidemiology: The ratio of males to females is approximately 1:1.11.The prevalence and proportion of pertussis in newborns in each year from 2014 to 2018: 2 cases(5.0%),7 cases(17.5%),12 cases(30.0%),6 cases(15.0%)and 13 cases(32.5%).There is no significant difference in the onset month.57.5%(23/40)of the children were from cities,and 42.5%(17/40)of the children were from rural areas.Clinical characteristics: 40 cases had cough(100%),34 cases(85%)with shortness of breath,21 cases(52.5%)with baby foam,22 cases(55%)with vomiting milk,21 cases(52.5%)with choking milk,17 cases(42.5%)with spasmodic cough,2 cases(5%)with a chicken-like echo after cough,3 cases(7.5%)with pursiness,1 case(2.5%)with apnea,1 case(2.5%)with suffocation.Blood-assisted examination: The average Leukocyte level of neonates with pertussis was 19.83±10.02*10^9/L;the lymphocyte ratio was 0.59±0.17;the platelet level was 499.15±178.61*10^9/L;84.21%(32/38)of the children had abnormal procalcitonin,but 89.47% of them PCT<0.75ng/mL.Pathogen examination: 50% of children with sputum culture positive.Imaging examination: There were 38 cases of neonatal with pertussis were examined and 73.68%(28/38)had abnormalities.Treatment: 40 neonatal pertussis were treated with azithromycin for anti-infective treatment after diagnosis;The use rates of the four aerosolized drugs of ambroxol,Pulmicort,concentrated sodium chloride and bronchodilator(Salbutamol and budesonide)were 90%(36/40),70%(28/40),37.5%(15/40),30%(12/40);vitamin K1 use rate was 72.5%(29/40);5%(2/40)used immune globulin;7.5%(3/40)children used ventilator assisted breathing.Prognosis: 37 cases(92.5%)were discharged after being completely improved;3 cases(7.5%)did not reach the discharge of the hospital sign and was discharged.There were no deaths during hospitalization.The influencing factors of neonatal pertussis duration: The results of multivariate Cox regression analysis showed that the time of first use of azithromycin,gestational age and ambroxol were statistically significant(P<0.05).Conclusion: In recent years,the prevalence of pertussis in children in Chongqing and the prevalence of pertussis in newborns have increased and there is no obvious seasonal distribution of pertussis in newborns.Cough and shortness of breathare the main manifestations in neonatal pertussis.Nearly half of the neonatal pertussis have spasmodic cough and a small number of neonatal pertussis have a chicken-like echo after cough,which may be accompanied by more atypical symptoms such as choking milk,vomiting milk,baby foam,suffocation,apnea,etc.Neonatal pertussis are susceptible to infection and the main pathogen is bacteria.Therefore,when the effect of neonatal pertussis treatment is poor,it can be combined with other antibiotics for anti-infective treatment.Azithromycin is the first choice antibiotic for neonatal pertussis which is supplemented with symptomatic supportive treatment with ambroxol,pulmicort,concentrated sodium chloride,bronchodilator(Salbutamol and budesonide),and vitamin K1.The time of first use of azithromycin,conceptus age and ambroxol are independent risk factors affecting the course of disease. |
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