Coqueluche néonatale

Abstract

Pertussis in neonates rarely occurs; 34 cases were recognized in 3 years in the last Renacoq study. Neonates and infants less than 3 months of age have low protection against pertussis because of the low level of specific antibodies in the mother's blood. Not unexpectedly mothers are the most common source of pertussis and are responsible for a postnatal contamination; congenital pertussis has not been bacteriologically proven. Neonates are hospitalized usually in the third week of life because of nonspecific cough, feeding difficulties, reccurrent cyanosis, and more rarely paroxysmal cough with inspiratory whooping. Isolation of B. pertussis can be negative but PCR is usually positive. Pulmonary complications are common, essentially bacterial and viral superinfections. Recurrent apneas and/or bradycardias, and digestive and neurological complications are responsible for a prolonged hospitalization (mean 19 days). Pneumoalveolar pertussis and encephalopathy are rare and have a poor prognosis despite aggressive support. Treatment is essentially symptomatic. Antimicrobial treatment with a macrolide such as erythromicin or derivatives reduces the contagious stage. Prophylactic erythromycin for 5 to 10 days after a suspected/confirmed case in the family is indicated for the neonate. Pertussis vaccination is not applicable in the neonatal period but can be started in premature infants in the third month of life before hospital discharge with 24 hours of cardiorespiratory monitoring.