摘要目的:探讨小婴儿重症百日咳的临床特点及换血治疗的有效性与安全性。方法:回顾性分析2023年1月至2024年8月吉林大学第一医院儿童医院新生儿科收治的接受换血治疗的0~3月龄重症百日咳病例。结果:6例患儿中，男2例，女4例，中位发病日龄30.5 d（10~54 d），早产儿2例。6例均有阵发性咳嗽和发热，阵发性青紫5例，呼吸暂停3例，鸡鸣样回声1例；并发症包括肺实变和（或）肺不张、呼吸衰竭6例，肺动脉高压和心功能不全各3例，肝大、百日咳脑病各2例；所有患儿血白细胞均明显升高，最高（32.2~69.6）×10 9/L，均有血红蛋白降低和血小板升高；C反应蛋白升高5例；6例于发病后10~21 d（中位日龄15.5 d）换血，每次换血量150~180 ml/kg，2例行二次换血，5例换血24 h内血白细胞、淋巴细胞、血小板计数显著下降，血红蛋白明显升高，肺动脉高压缓解，心功能不全恢复，呼吸状况明显改善。1例换血前已有多器官功能衰竭，最终死亡。 结论:重症百日咳小婴儿极易合并高白细胞血症，多器官衰竭发生前早期换血治疗可快速降低白细胞负荷，改善临床预后。

abstractsObjective:To study the clinical characteristics of severe pertussis in young infants and the efficacy and safety of exchange transfusion therapy.Methods:From January 2023 to August 2024, infants 0-3 months old with severe pertussis received exchange transfusion in the Department of Neonatology of our hospital were retrospectively analyzed.Results:A total of 6 infants (2 preterm) were enrolled, including 2 males and 4 females, with a median age of onset 30.5 d (10-54 d). Clinical symptoms included paroxysmal cough (6 cases), fever (6 cases), paroxysmal cyanosis (5 cases), apnea (3 cases) and whooping cough (1 case). Complications included pulmonary consolidation and/or atelectasis (6 cases), respiratory failure (6 cases), pulmonary hypertension (3 cases), heart failure (3 cases), hepatomegaly (2 cases) and pertussis encephalopathy (2 cases). All infants had markedly leukocytosis, with white blood cell (WBC) counts ranging from (32.2-69.6)×10 9/L. All had anemia, thrombocytosis and 5 had elevated CRP. All infants received exchange transfusion therapy (150-180 ml/kg of blood volume) 10-21 d (median 15.5 d) after onset. Two cases repeated transfusions. Within 24 h after transfusion, 5 infants showed significant decrease in WBC, lymphocyte and platelet counts and increase in hemoglobin levels. Pulmonary hypertension was resolved. Cardiac and respiratory functions were significantly improved in five infants. Only one case died due to multiple organ failure before transfusion. Conclusions:Severe pertussis in young infants is often complicated by markedly leukocytosis. Early exchange transfusion before the onset of multiple organ failure can rapidly reduce leukocyte burden and improve clinical outcomes.