The risk factors for severe infantile pertussis: report of 46 infants hospitalized with pertussis

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Objectives: To describe clinical features of infantile perussis and investigate the risk factors for severe infantile pertussis.Methods: Retrospective review of medical records of infants hospitalized with a diagnosis of pertussis in our hospital in past 20 years.The risk factors for severe disease (defined as in need of assisted ventilation) were analyzed.Results: 46 infants were enrolled;19 (41%) were <3 months old.None of the subjects had received immunization for pertussis.Complications included seizures in five cases (11%), hypoxia in 18 (39%), apnea in 12 (26%).Nine patients (20%) received assisted ventilation.The factors associated with an increased risk of severe disease were younger infants (<3 months) (odds ratio (OR) 7.3, 95% confidence interval (CI) 1.3 to 40.5), having a comorbidity (OR 8.8, 95%CI 1.3 to 40.5), presenting apnea (OR 22.4, 95%CI 3.6 to 140.0), elevated leukocyte count (>20×10<SUP>9</SUP>/l) on admission (OR 6.2, 95%CI 1.3 to 30.1), elevated lymphocyte count (>15×10<SUP>9</SUP>/l) on admission (OR 8.3, 95%CI 1.7 to 41.2), higher maximum C-reactive protein (>1.0 mg/dl) (OR 14.0, 95%CI 2.0 to 97.3).Conclusions: Severe disease is frequent in infantile pertussis.These risk factors should be evaluated early in the course, and those who have a risk factor should be treated carefully.