SUMMARYTreatment with high doses of calcium and calcitriol allowed progressive respiratory, musculoskeletal and neurological recovery. Although respiratory manifestations of rickets were described many years ago, the present case raises relevant issues about the level of diagnostic support, the risk of complications and how they should be assessed and monitored. BACKGROUND

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Introduction: Despite well-established immunisation programmes, the incidence of pertussis is increasing in several countries, particularly affecting young infants, who are susceptible to severe disease. We aimed to characterise pertussis cases treated in a paediatric intensive care unit. Methods: We performed a retrospective study based on review of the clinical charts of children with laboratory-confirmed pertussis admitted to a paediatric intensive care unit of an academic medical centre between January 2008 and July 2016. Results: Twenty-three children were identified, median age 40 days, 14/23 (60.9%) female, and 21/23 (91.3%) not vaccinated for Bordetella pertussis. Paroxysmal cough (100%) and apnoea (69.6%) were the most frequently found case-defining symptoms. Cyanosis and hypoxaemia (22/23, 95.7%), bradycardia (17/23, 73.9%) and apnoea (16/23, 69.6%) prompted most admissions. Fifteen patients (65.2%) needed respiratory support, invasive in 10 cases. Permissive hypercapnia was used in five patients and muscle relaxants in four. All patients had leukocytosis (median 26 600 cells/μl, 15 020-103 900 cells/μl). No leukoreduction techniques were used. Coinfection with other agents was identified in 10 patients and 14 had radiographic findings of pneumonia, which was healthcare-associated in three. Hyponatraemia was identified in five cases and seizures in one. There were no other complications of the disease and no deaths. Discussion: Disease complications, morbidity and mortality were less frequent than reported in other studies. Both prompt coinfection screening and treatment and the ventilation strategies used, sometimes with curari-Introdução: Apesar de programas de vacinação bem estabelecidos, a tosse convulsa tem reemergido em vários países, particularmente em pequenos lactentes suscetíveis a doença grave. Pretende-se caracterizar os internamentos por tosse convulsa numa unidade de cuidados intensivos pediátricos. Métodos: Estudo descritivo retrospetivo, por análise de processos clínicos de crianças com tosse convulsa confirmada laboratorialmente, internadas na unidade de cuidados intensivos pediátricos de um hospital de nível III entre janeiro de 2008 e julho de 2016. Resultados: Registaram-se 23 internamentos, mediana de idade 40 dias, 14/23 (60,9%) do sexo feminino, 21/23 (91,3%) não imunizados para Bordetella pertussis. A tosse paroxística (100%) e a apneia (69,6%) foram os sintomas definidores de caso mais frequentes. Os principais motivos de internamento foram episódios de cianose e hipoxemia (22/23, 95,7%), bradicardia (17/23, 73,9%) e apneia (16/23, 69,6%). Quinze doentes (65,2%) necessitaram de suporte ventilatório, invasivo em 10. Foi utilizada hipercapnia permissiva em cinco doentes e curarização em quatro. Verificou-se leucocitose em todos os doentes (mediana 26600 células/mL, 15 020-103 900 células/mL). Não foram usadas técnicas leucorredutoras. Identificaram-se agentes coinfetantes em 10 doentes e imagem radiológica de pneumonia em 14, nosocomial em três. Registaram-se cinco casos de hipona...

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