Objective:To learn the associated factors for fatal pertussis in children, so as to provide evidence for the prevention and treatment of fatal pertussis.

Methods:We searched Pubmed, Embase, Ovid, Web of Science, Wanfang Data, CNKI and CBM up to May of 2020 for the analytical studies about the associated factors for fatal pertussis in children, and used weighted mean difference (WMD) and odds ratio (OR) for a meta analysis.

Results :Finally 16 studies our of 5 418 preliminary ones were included. The meta analysis indicated that females (OR=1.36, 95%CI: 1.13-1.64) , low birth weight (WMD=-0.21, 95%CI: -0.40 - -0.03) , young age (WMD=-15.54, 95%CI: -28.97 - -2.10) , small gestational age (WMD=-0.96, 95%CI: -1.77 - -0.16), pertussis immunizations (OR=0.20, 95%CI: 0.11-0.36) , seizures (OR=9.88, 95%CI: 6.94-14.08), spasmodic cough (OR=0.61, 95%CI: 0.47-0.78), increased respiratory rate (WMD=10.68, 95%CI: 3.41-17.95) , increased heart rate (WMD=18.01, 95%CI: 7.33-28.69) , decreased percent oxygen saturation (WMD=-5.38, 95%CI: -10.36 - -0.39) , increased white blood cell counts (WMD=47.70, 95%CI: 40.95-54.46),increased absolute lymphocyte counts (WMD=17.03, 95%CI: 11.00-23.07) , increased absolute neutrophil counts (WMD=11.22, 95%CI: 6.04-16.40), pulmonary hypertension (OR=37.99, 95%CI: 16.76-86.13) , pneumonia (OR=37.65, 95%CI: 27.85-50.90) , encephalopathy (OR=23.38, 95%CI: 8.21-66.54) , any comorbidity (OR=3.00, 95%CI: 1.73-5.23), mechanical ventilation (OR=38.79, 95%CI: 11.81-127.42) , intubation (OR=297.36, 95%CI: 46.20-1 913.98), high-frequency ventilation (OR=18.34, 95%CI: 8.46-39.75) , extracorporeal membrane oxygenation (OR=47.49, 95%CI: 15.53-145.21), inhaled nitric oxide (OR=25.86, 95%CI: 8.52-78.43), use of vasoactive drugs (OR=54.42, 95%CI: 15.71-188.45) and blood exchange transfusion (OR=16.77, 95%CI: 6.53-43.09) were associated with fatal pertussis in children. The results of sensitivity analysis were stable. The results of Egger＇s assay showed publication bias in studies about spasmodic cough, encephalopathy and use of vasoactive drugs, while Begg＇s assay showed no publication bias at all.

Conclusions :Fatal pertussis in children is associated with gender, age, birth weight, gestational age as well as a variety of clinical features. Early identification and intervention are needed, and vaccination should be strengthened.