新生儿百日咳17例临床分析

Clinical characteristics of pertussis in 17 neonates

目的探讨新生儿百日咳的临床表现、诊断、治疗及预后。方法回顾性分析经百日咳鲍特菌聚合酶链反应确诊为百日咳的17例新生儿患者的临床资料。结果 17例患儿中,男8例、女9例,早产儿2例,发病日龄15～27 d。13例患儿有咳嗽患者接触史,4例早期有鼻塞、流涕等症状,5例有典型痉挛性咳嗽,1例咳嗽伴有鸡鸣样回声,6例咳嗽剧烈有面色通红,7例咳嗽剧烈时伴口唇发绀,2例住院前曾出现全身青紫,7例咳嗽后有吐奶,3例有发热。15例患儿外周血白细胞计数升高,为（12.57～79.63）×10^9/L,淋巴细胞比例为45.1%～75.2%。百日咳PCR拷贝数为7.12×10^2～1.04×10^8/m L。17例患儿均予静脉滴注红霉素治疗,均有明显好转,无死亡病例。结论对于有明确咳嗽患者接触史、出现阵发性咳嗽,外周血白细胞升高,并以淋巴细胞为主的新生儿需警惕百日咳可能,应及早行相关检查。

Objective To explore the clinical features, diagnosis, treatment, and prognosis of pertussis in neonates. Methods Clinical data from 17 neonates with pertussis confirmed by real-time polymerase chain reaction（PCR） of Bordetella pertussis, were retrospectively analyzed. Results In 17 neonates（8 males and 9 females）, 2 neonates were premature. The age at onset was from 15 to 27 days. Thirteen cases had a history of close contact with coughing patients, 4 cases had nasal congestion and runny nose in the early stage, 5 cases had typical spastic cough, one case had cough with inspiratory ＂whoop＂, 6 cases had flushing in face after severe cough, 7 cases had severe cough with cyanosis, 2 cases had systemic cyanosis before hospitalized, 7 cases had regurgitation after cough, and 3 cases had fever. Fifteen cases had increased peripheral blood white blood cell count,（ 12. 57- 79. 63）× 10^9/L, with lymphocyte at 45. 1 %- 75. 2 %. The PCR copy number of pertussis was 7. 12 × 10^2-1. 04 × 10^8/m L. Seventeen neonates were all treated with intravenous infusion of erythromycin, and all of them had a significantly improvement, and no death case. Conclusions Neonates with a history of contact with coughing patients, paroxysmal cough and increased of peripheral blood leucocyte presented as lymphocyte increase, need to be alert to pertussis, and relative examination should be taken as early as possible.