Severe hypoxaemia in pertussis.

Abstract

SUMMARY Overnight tape recordings of breathing movements, airflow, and arterial oxygen saturation from six infants aged 3 weeks to 7 months, who had cyanotic episodes associated with pertussis, were compared with recordings from 12 age matched healthy controls. In all patients clinically apparent apnoeic episodes were associated with the rapid onset and progression of central cyanosis. When overnight recordings were compared, patients with pertussis had a greater frequency of apnoeic pauses (particularly those ,12-0 seconds duration) and a greater frequency of episodes of hypoxaemia (oxygen saturation -80% for O0 5 seconds) associated with apnoeic pauses. In addition to episodes of hypoxaemia associated with a prolonged absence of breathing movements, patients with pertussis had frequent dips in oxygen saturation in association with continued breathing movements with and without continued inspiratory airflow. These episodes of hypoxaemia during continued breathing movements were more common in patients with pertussis.These findings suggest that episodes of abnormal apnoea accompanied by evidence of a mismatch between ventilation and perfusion of the lungs may produce the rapid onset of severe hypoxaemia in infants with pertussis.Apnoeic and cyanotic episodes often occur during pertussis particularly when it occurs in early infancy.' 2 The underlying mechanisms responsible for this dangerous complication are, however, unknown. In this paper we describe the results of an investigation by non-invasive techniques of infants with pertussis experiencing frequent and severe cyanotic episodes and compare these results with those from 12 healthy, age matched infants. Patients and methodsDetails of the six patients are given in the table. Pertussis was diagnosed by the presence of characteristic paroxysms of repetitive coughing that persisted for longer than one week and were associated with retching, vomiting, cyanosis, or convulsions in an infant who otherwise appeared to be in good health.3

Sudden infant death and prevalence of whooping cough in the Swedish and Norwegian communities

“…BP appears to adversely affect cardiorespiratory function, and prolonged apnoea as well as recurrent bradycardia in infected infants are reported [4,26,28]. Frequent apnoic pauses associated with rapid onset of severe hypoxaemia, possibly due to mismatch between ventilation and perfusion of the lungs among infected young infants have been reported [24]. In addition, characteristic findings of the inflammatory response to BP, such as inflammation of the mucosal lining of the respiratory tract and peribronchial lymphoid hyperplasia, have been observed in a proportion of SID victims [5,23].…”

A Controlled Study of the Relationship BetweenBordetella pertussisInfections and Sudden Unexpected Deaths Among German Infants

“…This is not surprising, because apnea is a common complication of pertussis among young infants. 16,17 In an attempt to assess how frequently SIDS is caused by Bordetella pertussis infections, we have been obtaining postmortem nasopharyngeal specimens (NPSs) since December 1990, in collaboration with several German institutes of legal medicine (ILMs). In our initial studies, we failed to culture B pertussis from infants with sudden unexpected deaths.…”

Bordetella pertussis infections and sudden unexpected deaths in children

“…It is biologically plausible that the organism can cause infant deaths. A common manifestation of B. pertussis infection in infancy is apnoea [9]. Severe apnoea can cause anoxia, and it seems likely that anoxia in an unattended child can proceed to death.…”