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Background Despite widespread vaccination programs, pertussis continues circulating within populations and remains a life-threatening infection in infants. While several mortality risk factors have been described, a comprehensive synthesis is lacking. We conducted a meta-analysis of studies investigating mortality risk factors in Pertussis infections and validated those factors in a large cohort. Methods Observational studies published in English were systematically searched in PubMed, EMBASE, and LiSSa databases from 01/2000 to 06/2024. The search yielded 816 unique citations. The primary outcome was mortality before discharge from the Pediatric Intensive Care Unit (PICU). Two independent reviewers assessed the risk of bias and extracted data. A REML-random effect model was used to calculate pooled prevalence and conduct the analysis. The identified risk factors were subsequently evaluated in a monocentric cohort of patients admitted to a tertiary hospital’s PICU for severe pertussis between January 1996 and December 2020. Data analysis was conducted between June and August 2024. Results Seventeen studies, including 2,725 patients, met the inclusion criteria. The pooled prevalence of mechanical ventilation, continuous renal replacement therapy, and Extracorporeal Membrane Oxygenation support were 55% (95% CI: 40–70; I 2  = 98), 15% (95% CI: 3–27; I 2  = 95), and 8% (95% CI: 3–12; I 2  = 93), respectively. The pooled mortality incidence was 19% (95% CI:12–26; I 2  = 96). Identified mortality risk factors included elevated heart rate, presence of pulmonary hypertension, presence of seizures, and elevated white blood cell (WBC) count. Validation in an 83-patient cohort (median age: 45 days, IQR: 30–55) revealed a mortality rate of 12%. Risk factors identified in the meta-analysis were significantly associated with non-survival in the cohort. A mortality prediction score was developed incorporating age < 30 days, heart rate > 200/min, and WBC > 30 G/l, achieving an area under the curve of 0.92 (95% CI: 0.86–0.99). Conclusion This meta-analysis identified a simple yet effective score to assess the severity of pertussis infection in infants admitted to PICU. Accurate risk stratification may enable timely treatment of critically ill patients, potentially improving outcomes. Trial registration : The study protocol was registered on PROSPERO: CRD42024582057. Graphic abstract

BackgroundDe-regulated host response to severe coronavirus disease 2019 (COVID-19), directly referring to the concept of sepsis-associated immunological dysregulation, seems to be a strong signature of severe COVID-19. Myeloid cells phenotyping is well recognized to diagnose critical illness-induced immunodepression in sepsis and has not been well characterized in COVID-19. The aim of this study is to review phenotypic characteristics of myeloid cells and evaluate their relations with the occurrence of secondary infection and mortality in patients with COVID-19 admitted in an intensive care unit.MethodsRetrospective analysis of the circulating myeloid cells phenotypes of adult COVID-19 critically ill patients. Phenotyping circulating immune cells was performed by flow cytometry daily for routine analysis and twice weekly for lymphocytes and monocytes subpopulations analysis, as well as monocyte human leukocyte antigen (mHLA)-DR expression.ResultsOut of the 29 critically ill adult patients with severe COVID-19 analyzed, 12 (41.4%) developed secondary infection and six patients died during their stay. Monocyte HLA-DR kinetics was significantly different between patients developing secondary infection and those without, respectively, at day 5–7 and 8–10 following admission. The monocytes myeloid-derived suppressor cells to total monocytes ratio was associated with 28- and 60-day mortality. Those myeloid characteristics suggest three phenotypes: hyperactivated monocyte/macrophage is significantly associated with mortality, whereas persistent immunodepression is associated with secondary infection occurrence compared to transient immunodepression.ConclusionsMyeloid phenotypes of critically ill COVID-19 patients may be associated with development of secondary infection, 28- and 60-day mortality.

BackgroundAcute fulminant myocarditis in children is associated with elevated mortality and morbidity with few advances in its medical management. Here we report a preliminary experience of children treated with IL-1 receptor antagonist associated with rapid myocardial function recovery.MethodsA retrospective case series of children admitted in the Pediatric Intensive Care Unit of the Bicêtre Hospital (AP–HP Paris Saclay University) between April 2020 and January 2022 with acute myocarditis. Children were treated with subcutaneous anakinra (an IL-1 receptor antagonist). Patients characteristics, and outcome are reported.ResultsOf 10 children admitted with acute fulminant myocarditis, eight were treated with sub-cutaneous anakinra. Seven children had SARS-CoV-2 post-infective myocarditis associated with multisystem inflammatory syndrome in children (MIS-C) and one child Parvovirus B19 myocarditis. In all patients a rapid (< 24 h) improvement in myocardial function was observed with concomitant decrease in myocardial enzymes. All patients survived with full myocardial recovery.ConclusionsIn this pilot study, use of IL-1 receptor antagonist in the initial treatment of acute fulminant myocarditis in children seems to be associated with rapid stabilization and recovery.

Background Severe acute viral bronchiolitis is a common cause of admissions to pediatric intensive care units (PICUs), resulting in a significant organizational burden each winter. The recent introduction of generalized neonatal prophylactic therapies using Nirsevimab, a monoclonal antibody targeting the respiratory syncytial virus (RSV), has significantly reduced consultations and hospitalizations. However, its impact on the medico-economic aspects of the PICU remains poorly defined. Methods We analyzed all infants admitted to our unit for severe acute bronchiolitis over six consecutive epidemic periods (September to March) and examined the effect of Nirsevimab generalized prophylaxis on PICU admissions during the 2023–2024 period. Results Between 2018 and 2024, 572 out of, 3728 infants under 6 months of age were admitted to the PICU for severe acute bronchiolitis during six epidemic periods. The average percentage of infants with bronchiolitis admitted to the PICU was 15.3% (95% CI 14.2–16.5), with a net decrease during the 2023–2024 period (8.5%) compared to the 2022–2023 period (17.6%). Patients’ characteristics were similar, as were the supporting therapies. The causes of bronchiolitis were identical, with 83% and 77% secondary to RSV. PICU duration was significantly reduced during the last period from 4.4 days (95% CI 3.8–5.9) to 3.3 days (95% CI 2.6–4). The medico-economic impact was significant, with a cost reduction for acute severe viral bronchiolitis PICU total stays from €210,105 to €121,044 per annual epidemic without a change in the return on investment. Conclusions The introduction of generalized neonatal prophylaxis with Nirsevimab significantly impacts the burden of severe acute bronchiolitis in the PICU.