Objectives: To investigate the efficacy and safety of exchange transfusion in neonates with severe pertussis.
Methods: A retrospective analysis was performed for the medical data of five neonates with severe pertussis who underwent exchange transfusion in the Department of Neonatology, Hunan Children's Hospital, from August 2019 to March 2024. The clinical characteristics of the patients were summarized, and the efficacy and adverse reactions of exchange transfusion were analyzed.
Results: All five neonates had the symptoms of hypoxemia, recurrent apnea, and heart failure and required invasive mechanical ventilation. Two cases of pulmonary hypertension were observed, one of which was complicated by decompensated shock. Before exchange transfusion, the five children had a median leukocyte count of 82.60×109/L, a median absolute lymphocyte count of 28.20×109/L, and a median absolute neutrophil count of 43.10×109/L, and reexamination at 4 hours after exchange transfusion showed that these values decreased to 28.40×109/L, 7.60×109/L, and 15.40×109/L, respectively. The four children who underwent exchange transfusion in the early stage of cardiopulmonary failure showed varying degrees of improvement in oxygenation and a reduction in the partial pressure of carbon dioxide, and they were discharged after improvement; the one child who underwent exchange transfusion in the late stage of cardiopulmonary failure ultimately died. No child experienced severe adverse reactions related to exchange transfusion.
Conclusions: For neonates with severe pertussis, initiating exchange transfusion in the early stages of cardiopulmonary failure can effectively reduce leukocyte levels, potentially improve survival rates, and is relatively safe.
目的: 探索换血治疗在新生儿重症百日咳中的有效性及安全性。方法: 回顾性分析2019年8月—2024年3月湖南省儿童医院新生儿科收治的5例行换血治疗的新生儿重症百日咳患儿的病例资料，总结患儿临床特点，分析换血治疗疗效和不良反应。结果: 5例患儿均有低氧血症、反复呼吸暂停及心力衰竭，均需有创机械通气，2例合并肺动脉高压，其中1例并发失代偿性休克。5例患儿，换血前中位白细胞计数为82.60×109/L，中位淋巴细胞绝对计数为28.20×109/L，中位中性粒细胞绝对计数为43.10×109/L，换血后4 h复查均下降，分别为28.40×109/L、7.60×109/L、15.40×109/L。在心肺衰竭早期行换血治疗的4例患儿均有不同程度的氧合改善和二氧化碳分压下降，好转出院；在心肺衰竭晚期行换血治疗的1例患儿最终死亡。无患儿出现换血相关的严重不良反应。结论: 新生儿重症百日咳在心肺衰竭早期启动换血治疗可有效减少白细胞水平，可能提高生存率，且相对安全。.
Keywords: Exchange transfusion; Hyperleukocytosis; Neonate; Severe pertussis.