PC3074: High Flow Nasal Oxygen in Management of Pertussis in Pediatrics

Background: Pertussis (or whooping cough) is a frequent and important infectious disease of the respiratory tract, mainly caused by the Gram-negative rod bacterium Bordetella pertussis. They can range from asymptomatic, apnea and uncharacteristic cough to typical coughing spells with post tussive phlegm and/or vomiting, and duration also varies between a few days and several months. We noted the younger the age of the affected baby the more clinical symptoms, most of the cases required admission either to the HD unit or PICU unit after we applied HFNC for most of them showed better response. High flow nasal cannula (HFNC) is a relatively new non-invasive ventilation therapy. that HFNC is a relatively safe, well-tolerated, and feasible method for delivering oxygen to children with few adverse events having been reported. Different mechanisms including washout of nasopharyngeal dead space, increased pulmonary compliance and some degree of distending airway pressure may be responsible for the effect.

Methods: This hospital review was conducted in Nizwa city, Sultanate of Oman, from September 2020 to November 2021. Infants were recruited at Nizwa Hospital. Male and female infants were eligible for enrollment as index cases if they were being aged ≤6 months, either with a persistent cough for at least 5 days associated with at least one symptom among respiratory distress, apnea, inspiratory “whooping”, or post tussive vomiting or with a persistent cough and a confirmed case of whooping cough in the entourage. Upon enrollment of index case, nasopharyngeal samples were collected, and data on age, sex, size and weight, birth information, pertussis vaccination history, type and duration of pertussis-related symptoms, biological test results, antibiotic treatment type and duration, previous consultation, family composition and the case of cough in the entourage, animal contact, were collected. All included cases admitted either to HD unit or PICU, all requiring oxygen support either to keep accepted saturation or to overcome apneic spells & increased work of breathing.

Results: The results were subsequently analyzed. Results A total of 166 respiratory distress children were enrolled during the study period. Only 11 children (6.62%) failed HFNC therapy, compared with 64 children (38.55%) in a conventional oxygen therapy group. After adjusting for body weight, underlying diseases, and respiratory distress score, there was an 85% reduction in the odds of treatment failure in the HFNC therapy group. Most children in the HFNC therapy group had significant improvement in clinical respiratory score, heart rate, and respiratory rate at 240, 360, and 120 min compared with conventional oxygen therapy.

Conclusion: HFNC therapy revealed a potential clinical advantage in managing children hospitalized with pertussis & pertussis illness admitted with respiratory distress compared with conventional respiratory therapy. The early use of HFNC in children with moderate-to-severe respiratory distress may prevent endotracheal tube intubation.