{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:03:30Z","timestamp":1784527410689,"version":"3.55.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Critical pertussis remains a critical health concern in infants and is characterized by severe leukocytosis, respiratory failure, and multisystem involvement. Despite global vaccination efforts, outbreaks continue to occur, particularly among unvaccinated or partially vaccinated infants. This study aimed to describe the clinical, laboratory, and management characteristics of critically ill infants with critical\n                      <jats:italic>Bordetella pertussis<\/jats:italic>\n                      in the southwest region of Saudi Arabia, with a focus on comparing survival and non-survival outcomes\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort study was conducted involving 70 infants hospitalized for severe pertussis between January 2024 and April 2025. Data collected included demographic details, presenting symptoms, comorbidities, vital signs, laboratory parameters [e.g., white blood cell (WBC) count, inflammatory markers, liver enzymes], treatments received (e.g., macrolides, exchange transfusions, leukoreduction therapies), and clinical outcomes. Statistical analyses included descriptive statistics and comparative tests (\n                      <jats:italic>t<\/jats:italic>\n                      -test, Mann\u2013Whitney U test, chi-squared test).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 70 infants, the median age was 3 months, with 46.4% of the infants aged &amp;lt; 3 months. Non-survivors (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094) exhibited significantly higher leukocyte counts (median WBC, 87.5\u2009\u00d7\u200910\n                      <jats:sup>3<\/jats:sup>\n                      \/\u00b5L) and neutrophil levels, profound hypoxemia, and higher inflammatory marker levels (C-reactive protein, erythrocyte sedimentation rate) than survivors. They also more frequently had coexisting conditions, such as congenital heart disease and genetic disorders. Clinical features, such as apnea, seizures, and hypoxemia, were strongly associated with death. All fatal cases involved severe pulmonary hypertension, which necessitated aggressive interventions, including exchange transfusions, inhaled nitric oxide, and inotropes. The laboratory findings of non-survivors showed marked leukocytosis, elevated liver enzyme levels, hyponatremia, and thrombocytopenia. Therapeutic efforts, including leukoreduction and advanced supportive measures, were more prevalent in non-survivors than in survivors but were insufficient to alter outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Critical pertussis primarily affects unimmunized infants &amp;lt;3 months and is associated with severe illness and a notable fatality rate despite intensive care. Strengthening maternal and infant immunization, along with early risk identification and prompt intervention, is essential. Further research and public health efforts are needed to reduce disease burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1881833","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:34:20Z","timestamp":1784525660000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and laboratory characteristics of critical Bordetella pertussis in hospitalized infants in the Southwest region of Saudi Arabia"],"prefix":"10.3389","volume":"14","author":[{"given":"Ali Alsuheel","family":"Asseri","sequence":"first","affiliation":[{"name":"Department of Child Health, College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norah","family":"Alshehri","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Units, Aseer Health Cluster","place":["Abha, Saudi 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