XLIV Jornadas Nacionais de Neonatologia. Évora. 2015. Poster
Background. Bordetella pertussis causes a highly contagious disease. Infants younger than 1 year old are the most vulnerable. Both encephalopathy and hyperleukocytosis are rare, but severe, complications of pertussis. Case Report. A healthy female term newborn, at the 15th day of life, develops cough, prostration and refusal to eat, in a family context of acute respiratory illness. Admitted to a level II neonatal unit, azithromycin and support measures were started. Due to respiratory failure, she was transferred to a level III unit on mechanical ventilation, where pertussis infection was confirmed by PCR in blood. Hyperleukocytosis developed (114x109/L) and seizures occurred. EEG revealed multifocal paroxystical activity. Lumbar puncture revealed increased protein levels (296.3mg/dL) and normal cell count (5cel/microL). Brain magnetic resonance imaging showed multifocal infracentimetric white matter infarctions. Hyperleukocytosis was promptly controlled with overhydration. She completed 5 days of azithromycin, 5 days on mechanical ventilation and 10 days on nasal CPAP. After 21 days in the NICU, she returned to the level II unit still on oxygen, for follow on care. Presently, at 18 months of age, no respiratory, neurological or developmental sequelae are present. Discussion. Very young infants are at increased risk of developing severe pertussis disease. Persistent hyperleukocytosis (>100x109/L) is often associated with fatal course. Several techniques rapidly reduce the impact of severe leukocytosis, as exchange transfusion and leukapheresis. In this case, hyperleukocytosis was reduced by half in 10 hours through overhydration, reducing the effects of hyperviscosity and improving the outcome.
Palavras Chave: Encephalopathy, hyperleukocytosis, neonate, overhydration, pertussis.