Background and aims The World Health Organisation estimates that 1.8 million children under five die of pneumonia each year (WHO, 2014). Children affected by hemodinamically significant congenital heart disease (CHD) experince acute respiratory illness (ARI) and frequency hospitalizations. The aim of our study was to describe the clinical course of ARI in children with various CHD.
Methods In this retrospective, unicenter, observational study were enrolled all children with ARI and associated CHD, hospitalised in Department of Pulmonology within 1 year (Juanary-Decembry 2016). Protocol study included anamesis, clinical status, aetiology, type of CHD and ARI, laboratory examinations, Rx thoracic, ECG, echocardiography, CT and in same cases.
Results Children with CHD had about 0.5% of all hospitalizations. Overall 46 children were enrolled: mean age was 13.5 months (3 months to 10 years), 54.3% were boys, 21 ptc (40.7%) with hemodinamically semnificant CHD; 10 (21.7%) children required intensive care measures and the period of hospitalisation was higher than the average for children without CHD (9.6 versus 7.4 days, p<0.05); more than 70% had varios pneumonies, 16 (35%) children with severe ARI receiving treatment support heart function. The most frequant were CHD with left-to-right shunt: ventricular septal defect (26.1%), atrial sept defect (13%), 5 infants for each atrioventricular canal and permiable ductus arteriosus. 7 children (13.5%) required repeated hospitalizations during the year. ARI aetiology and antibiotic treatment of specific bacterial infection found in sputum the follwoing: 1) Gram-positive bacteria, genus Streptococcus and Staphylococcus in 62.5% cases and, 2) fungal infection Candida albicans in about one half of patients. Simultaneously, sputum analysis has found associated infections in 22 (47.8%) cases. This infections required specific antibacterial and antifungal therapy to prevent infectious cardiac and respiratory complications. Clinical and instrumental evaluation (ECG, ecocardiography) confirmed improving cardiac function following hospital discharge for all the children in our study.
Conclusions Infants with hemodinamically significant CHD have a major risc of ARI, frequent pneumonia (70% of cases). The association of severity of ARI, specific infections and CHD requires multidisciplinary approach to prevent major cardiac and respiratory complications.
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