Objective  To analyze the clinical characteristics of hospitalized children with pertussis in a tertiary grade 3 children's hospital in Northwest China and evaluate their economic burden.

Methods  Demographic and clinical data of children diagnosed with pertussis and admitted to a tertiary grade 3 children’s hospital in Shaanxi Province from February to August 2024 were collected. Clinical features were described, and Bonferroni multiple comparison adjustment was used to analyze differences in hospitalization duration across initial antibiotic regimens. Generalized Linear Models (GLM) were further employed to identify influencing the length of stay and hospitalization costs factors, Poisson regression calculated the adjusted incidence rate ratio (aIRR) for hospitalization duration, and Gamma regression calculated the adjusted cost ratio (aCR) for hospitalization costs.

Results  A total of 630 children with pertussis were included. The median age was 60 months (IQR: 5–86 months), with a median hospitalization duration of 6 days (IQR: 5–8 days) and median hospitalization cost of ¥4,551 (IQR: ¥3,527–5,883). Patients aged <3 months had significantly higher incidences of underlying diseases, paroxysmal cough, pneumonia, respiratory failure, and encephalopathy (P<0.05). Multivariable analysis revealed that underlying diseases, pneumonia, and/or respiratory failure were significant factors influencing both hospitalization duration and costs (P<0.05). Younger age correlated with prolonged hospitalization: infants <3 months had 10.7% longer staysthan those >24 months. Patients treated with trimethoprim-sulfamethoxazole (TMP-SMX)had the shortest median hospitalization duration (5 days, IQR: 4–7 days) and lowest median cost (¥3,483, IQR: ¥2,949–4,300), which was 0.9 times that of macrolide-treated patients.

Conclusions  Children with pertussis who develop complications face a heavier economic burden. Clinical practice should enhance the prevention and management of the disease in younger children and those with complications. Based on the patient's clinical presentation, appropriate adjustments to the first-line antibiotic treatment may be considered to reduce the economic burden on children of patients.