Infant pertussis deaths and the management of cardiovascular compromise

: Infants infected with Bordetella pertussis in the first few weeks of life are at risk of death from ‘overwhelming cardiovascular compromise despite intensive care support’. The mechanisms of this severe disease are not completely understood. Three case histories, including that of one infant who survived, are presented. Two of the patients died despite intensive therapy with pressors and, in one child, milrinone. The third child survived following treatment with nitric oxide and sildenafil. Hence, sildenafil in combination with nitric oxide shows promise as a therapy for the haemodynamic consequences of pertussis toxaemia and this should prompt clinical trials for their efficacy for this condition.