Whooping cough is best treated within two weeks before it occurs, and if your child has symptoms that are suspected of whooping cough, it is important to seek medical help from a medical professional as soon as possible.
Written by丨Huang Siyu
More than 4-month-old Youyou (pseudonym) suffered from whooping cough for two days, and was admitted to the comprehensive ICU of the Affiliated Children's Hospital of Zhejiang University School of Medicine on the third day. He underwent 2 exchange transfusions in the ICU, replacing 4 times the blood in his body, and after a week, Youyou's condition finally stabilized and he was transferred to a general ward.
Now Youyou has been discharged from the hospital in good health. Dr. Ye Sheng, director of the comprehensive ICU of the Hubin Campus of Zhejiang University Children's Hospital, reminded that whooping cough is mainly mild, and there is no need to panic excessively, but infants under 1 year old are at a higher risk of severe disease after being infected with whooping cough.
The 4-month-old baby was severely ill with whooping cough and was admitted to the ICU
"This baby's white blood cell index is not ordinarily high, it is very high. ”
Ye Sheng recalled that when he was sent to the comprehensive ICU of the Hubin Campus of Zhejiang University Children's Hospital, all the doctors in the department were worried about Youyou. Four-month-old babies usually have no more than 12×109/L white blood cells, but soon after Youyou was admitted to the hospital, the white blood cells rose to 97×109/L, which is 8 times the upper limit of normal.
Youyou coughs very badly, a paroxysmal spasmodic cough with respiratory distress and must be oxygenated. Ye Sheng judged that Youyou was very likely to have whooping cough, and immediately applied for a whooping cough nucleic acid test, and the results confirmed his judgment.
Treatment of whooping cough with one antibiotic is usually sufficient, but Youyou's symptoms are severe and conventional treatment may not work as well. Based on years of clinical experience, Ye Sheng was given a combination of cefoperazone sodium sulbactam sodium and compound sulfamethoxazole. At the same time, continue to let Youyou inhale oxygen, reduce the burden on the lungs, and maintain oxygenation in the body.
Youyou is accompanied by pulmonary hypertension and pneumonia, and there are also abnormalities in the cardiovascular system. To this end, the comprehensive ICU team of Hubin Campus used corresponding supportive drugs to maintain excellent heart, lung and kidney function, and ensure adequate cerebral perfusion to reduce brain function damage. They also monitor your blood pressure at all times and make medication adjustments at any time to reduce unnecessary oxygen consumption. At the same time, body fluids are closely monitored and finely adjusted to ensure that dehydration or edema do not occur.
With medication and careful monitoring care, Youyou's condition improved. However, Youyou's white blood cells are still high, indicating that an inflammatory storm is taking place in the body. In order to control the disease and reduce the damage of pertussis bacteria to multiple organs in the body, it is essential to lower the white blood cells as soon as possible.
But how?
Two transfusions were exchanged to remove 4 times the blood of the whole body
Ye Sheng immediately thought of exchange transfusion. In this therapy, deep venous catheterization creates two channels, one that feeds fresh blood into the patient's body and the other that sends an equal amount of blood out of the body, to act as a therapy and alleviate the condition.
Exchange transfusion therapy has been relatively mature in clinical practice, but out of prudence, Ye Sheng first initiated a discussion of difficult cases in the department. After comprehensive ICU discussion, all the doctors and nurses agreed that Youyou met the indications for exchange transfusion. Subsequently, Ye Sheng initiated a hospital-wide general consultation and discussed with departments such as infectious diseases, respiratory, hematology-oncology, and neonatology. Experts are unanimous in favor of the use of exchange transfusion for Youyou as soon as possible.
The general consultation of the whole hospital was carried out at about 4 p.m., and the exchange transfusion therapy for Youyou was carried out in the comprehensive ICU in the evening of the same day. Youyou, which is only more than 4 months old, is very slender, and it is very difficult to establish deep venous access. However, with years of treatment experience, Xie Wangfang, the head nurse of the comprehensive ICU, established two deep venous channels very accurately.
The doctors and nurses were by your side that night, and they were pleased to see that the exchange transfusion was very successful, and the white blood cells of Youyou dropped from the highest 97×109/L to about 50×109/L.
This treatment replaced twice as much blood in Yuyu's body. However, a day later, Youyou's white blood cells showed signs of rising again. Ye Sheng invited Chief Physician Huang Lisu and Chief Physician Hua Chunzhen of the Department of Infectious Diseases to discuss and decided to perform the second exchange transfusion for Youyou. This treatment replaced twice the blood in Youyou's body, but fortunately, the effect was still significant, and Youyou's white blood cells dropped to between 20×109/L and 30×109/L, and tended to be stable.
Not only that, but the condition of all the systems of the body has improved significantly. A few days after Youyou's condition stabilized, Director Ye Sheng believed that Youyou could be transferred from the general ICU to the infectious disease ward.
After entering the infectious disease ward, Youyou's condition continued to improve, and he didn't need oxygen soon after. Two days after stopping the oxygen inhalation, experts from various departments jointly assessed that Youyou had recovered and could be discharged. So far, Youyou has spent 14 days in the Children's Hospital of Zhejiang University, of which more than a week has been treated in the ICU.
Ye Sheng told the "medical community" that severe whooping cough also led to mild pulmonary hypertension complicated by Youyou, but fortunately, timely exchange transfusion treatment prevented pulmonary hypertension from mild to severe, and also shortened Youyou's recovery time. He stressed that exchange transfusion must be performed before the onset of multi-organ failure to ensure maximum benefit for the child.
Dr. Ye Sheng visits Youyou Courtesy of Zhejiang University Children's Hospital
If your child has these symptoms, you should be wary of whooping cough
After Youyou was transferred out of the comprehensive ICU, Ye Sheng posted a video on Weibo to express his joy.
Screenshot source/Weibo @Yesheng Doctor
A few days later, he posted another video reminding parents that for young babies under 1 year old, whooping cough is sometimes atypical, especially in the context of the current epidemic, and it is not necessary to see continuous spasmodic cough and chirp-like echoes to consider whooping cough. As long as the baby's basic physical condition declines, such as poor feeding, poor mental state, poor breathing, etc., especially if you have been in contact with patients with chronic cough, it is recommended to screen for whooping cough.
Dr. Yip Sheng pointed out that whooping cough is mainly mild and there is no need to panic excessively, but babies under 1 year old are more likely to develop severe symptoms after pertussis infection. Babies under 1 year of age who have the following symptoms are advised to seek medical attention for pertussis screening:
- apnea, respiratory distress, respiratory failure;
- Poor feeding, decreased appetite, poor mental state;
- spasms, convulsions;
- Cyanosis of the skin.
After going to the hospital for examination, if the baby is found to have complications such as pneumonia, pulmonary hypertension, cardiac insufficiency, acute kidney injury, or white blood cells exceeding 30×10⁹/L, doctors and parents should be vigilant against whooping cough.
Dr. Ye Sheng reminded that vaccination is still the most direct and effective way to prevent whooping cough, and it can effectively reduce the rate of severe disease after infection. Unfortunately, Youyou didn't have time to get vaccinated this time.
For older school-age children, Ye Sheng pointed out that if a child in the class is diagnosed with whooping cough, parents should pay close attention to the child's physical condition and be vigilant against infection. If your child has been coughing for more than 2 weeks and pathogens such as influenza, COVID, or respiratory syncytial virus have been ruled out, pertussis should also be considered.
"If the child's cough is particularly obvious and the clinical diagnosis is suspected to be whooping cough, then you can preemptively take the medication without waiting for the pertussis nucleic acid test results to come out. Of course, the diagnosis of suspicion needs to be carried out by a professional doctor, not by the parents. "Whooping cough is best treated within two weeks before it occurs, so if your child has symptoms that are suspected of pertussis, it is important to seek professional help as soon as possible." ”
According to the Medical Community Pediatric Channel O10