新生儿及婴儿百日咳临床特点分析

Analysis of clinical features of neonatal and infantile pertussis

目的分析新生儿及婴儿百日咳的临床特点及转归。方法回顾性分析2021年9月至2022年9月于苏州大学附属儿童医院收治的百日咳新生儿及婴儿的临床资料,分别从年龄、病情严重程度及是否混合感染进行分组分析。结果新生儿及婴儿百日咳共40例,所有患儿予积极抗感染治疗后均好转出院。新生儿组呼吸暂停、低钠血症的发生率高于非新生儿组(均P<0.05)。与非新生儿组相比,新生儿组外周血白细胞计数[20.9(15.0,28.7)×10^(9)/L vs.16.6(11.3,21.2)×10^(9)/L]、中性粒细胞计数[4.6(3.7,7.9)×10^(9)/L vs.3.2(2.1,5.3)×10^(9)/L]、γ-谷氨酰基转移酶水平[78.0(50.2,109.4)U/L vs.22.5(15.1,38.9)U/L]、住院时间[21.5(16.8,25.0)d vs.11.5(9.0,19.8)d]及用氧时间[7.0(0,21.0)d vs.0(0,2.3)d]均显著升高(均P<0.05),IgA水平[0.02(0.02,0.04)g/L vs.0.05(0.03,0.09)g/L]显著降低(P<0.05)。重症组发病日龄<3月龄、发热、喘息、气促、剧烈咳嗽后发绀、呼吸暂停、心率下降、肺部听诊湿啰音、呼吸衰竭、心功能不全、低钠血症、CRP>8 mg/L比例、肺部点片状/斑片状阴影比例,以及丙种球蛋白、心血管活性药、有创通气使用率均高于非重症组(均P<0.05)。与非重症组相比,重症组外周血白细胞计数[21.0(15.4,37.4)×10^(9)/L vs.17.5(11.8,21.2)×10^(9)/L]、中性粒细胞计数[5.6(4.0,10.7)×10^(9)/L vs.3.2(2.3,4.6)×10^(9)/L]、中性粒细胞计数/淋巴细胞计数[(0.6±0.4)vs.(0.3±0.2)]、系统免疫炎症指数[237.5(109.5,424.9)vs.135.9(75.4,190.5)]、γ-谷氨酰基转移酶水平[53.2(31.6,87.4)U/L vs.29.5(15.2,65.0)U/L]、用氧时间[18.0(12.8,22.5)d vs.0(0,0)d]及住院时间[24.5(21.8,31.2)d vs.12.0(9.0,16.8)d]均显著升高(均P<0.05),IgA水平[0.03(0.02,0.04)g/L vs.0.05(0.03,0.09)g/L]显著降低(P<0.05)。混合感染组住院时间及发热比例均高于单纯百日咳感染组(均P<0.05)。结论婴儿百日咳不易早期识别,新生儿期感染更易出现呼吸暂停、低钠血症、白细胞计数升高等重症表现,用氧时间更长;当患儿出现发热、喘息、气促、心率下降、肺部湿啰音以及肺部点片状/斑片状阴影,早期CRP、中性粒细胞计数/淋巴细胞计数及系统免疫炎症指数的升高、IgA降低等需警惕病情加重。混合感染者发热比例较高。

ObjectiveTo analyse the clinical features and prognosis of pertussis in neonates and infants.MethodsThe clinical data of neonates and infants with pertussis hospitalized in Children′s Hospital of Soochow University from September 2021 to September 2022 were retrospectively analyzed and grouped in terms of age,the severity of the disease,and whether a mixed infection,respectively.ResultsA total of 40 infants with pertussis were analyzed.All cases showed improvement and were discharged after receiving active anti-infective treatment.In the neonatal group,higher rates of apnea and hyponatremia were observed compared to the non-neonatal group(all P<0.05).Additionally,peripheral blood leukocyte counts[20.9(15.0,28.7)×10^(9)/L vs.16.6(11.3,21.2)×10^(9)/L],neutrophil counts[4.6(3.7,7.9)×10^(9)/L vs.3.2(2.1,5.3)×10^(9)/L],γ-glutamyltransferase levels[78.0(50.2,109.4)U/L vs.22.5(15.1,38.9)U/L],duration of hospitalization[21.5(16.8,25.0)d vs.11.5(9.0,19.8)d],and duration of oxygen use[7.0(0,21.0)d vs.0(0,2.3)d]were higher in the neonatal group than in the non-neonatal group(all P<0.05).However,the IgA level[0.02(0.02,0.04)g/L vs.0.05(0.03,0.09)g/L]was significantly lower in the neonatal group than in the non-neonatal group(P<0.05).In the severe group,the proportion of onset age of less than 3 months,fever,wheezing,shortness of breath,cyanosis after rough cough,apnea,decreased heart rate,wet rales on lung auscultation,respiratory failure,cardiac insufficiency,hyponatremia,CRP>8 mg/L,spotty/patchy shadows in the lungs,as well as the use of gammaglobulin,cardioactive drug and invasive ventilation,were higher than those in the non-severe group(all P<0.05).Furthermore,peripheral blood leukocyte counts[21.0(15.4,37.4)×10^(9)/L vs.17.5(11.8,21.2)×10^(9)/L],neutrophil counts[5.6(4.0,10.7)×10^(9)/L vs.3.2(2.3,4.6)×10^(9)/L],neutrophil to lymphocyte ratio[(0.6±0.4)vs.(0.3±0.2)],systemic immune-inflammation index[237.5(109.5,424.9)vs.135.9(75.4,190.5)],γ-glutamyltransferase level[53.2(31.6,87.4)U/L vs.29.5(15.2,65.0)U/L],duration of oxygen use[18.0(12.8,22.5)d vs.0(0,0)d],and duration of hospitalization[24.5(21.8,31.2)d vs.12.0(9.0,16.8)d]were higher in the severe group than those in the non-severe group(all P<0.05).However,the IgA level[0.03(0.02,0.04)g/L vs.0.05(0.03,0.09)g/L]was significantly lower in the severe group than in the non-severe group(P<0.05).The mixed infection group had a longer duration of hospitalization and a higher proportion of fever than the single infection group(all P<0.05).ConclusionEarly detection of infantile pertussis can be challenging.Neonates with pertussis tend to experience severe symptoms,such as apnea,hyponatremia,elevated white blood cell count,and longer duration of oxygen use.Symptoms such as fever,wheezing,shortness of breath,decreased heart rate,wet lung rales,and spotty/patchy shadows in the lungs,as well as early elevated CRP,neutrophil to lymphocyte ratio,systemic immune-inflammation index,and decreased IgA levels are indicators of disease exacerbation.In mixed infections group,there is a higher proportion of fever.