Screening and follow-up for congenital heart disease in children aged 0-3 years in rural areas of Chongqing, China / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To examine the incidence of congenital heart disease (CHD) in children aged 0-3 years in the rural areas of Chongqing, and to determine the suitable "screening-diagnosis-follow-up" system and screening indicators for CHD in these areas.</p><p><b>METHODS</b>Children aged 0-3 years from rural areas of the Fuling Disctrict of Chongqing were selected by cluster sampling. Using the "screening-diagnosis-evaluation system" employed at the levels of village/town, district/county, and province/city, the children were screened for seven indicators, i.e., family history of CHD, dyspnea, cyanosis, unique facial features, other congenital malformations, heart murmurs, and blood oxygen saturation (SpO<95%). Children who were positive for one or more indicators accepted echocardiography (ECG) for the diagnosis of CHD. CHD patients were evaluated for disease progression, given guided treatments, and followed-up by pediatric cardiologists.</p><p><b>RESULTS</b>Screening was performed for 10 005 out of the 10 281 children enrolled in the study (97.32% response rate). Among the 175 children who were positive for the indicators, 166 underwent ECG and 60 (0.6‰) were diagnosed with CHD, including 46 cases of simple CHD (76.65%), 11 cases of combined CHD (18.33%), and 3 cases of complex CHD (5.00%). Of the 7 screening indicators, heart murmur had the largest area under the ROC curve for the diagnosis of CHD. In addition, a combination of screening indicators (heart murmur, unique facial features, and other congenital malformations) was most effective for screening out CHD. The CHD patients were given surgical or intervention treatments, and followed up for 6 to 18 months. Ten patients improved without treatment, 13 patients received interventional or surgical treatment, 1 patient died of non-cardiac reasons. The remaining 36 patients were subjected to further follow-up.</p><p><b>CONCLUSIONS</b>Heart murmur alone and in combination with unique facial features and other congenital malformations are valuable tools for CHD screening in children aged 0-3 years. The "village/town-district/county-province/city" screening-diagnosis-evaluation systems are useful for the early detection, diagnosis, and treatment of CHD in infants and young children from the rural areas of Chongqing.</p>

Effect and safety analysis of carvedilol with metoprolol on children with dilated cardiomyopathy / 中华实用儿科临床杂志

Objective To compare the effect,safety and tolerance of carvedilol and metoprolol on children with dilated cardiomyopathy(DCM).Methods Children with DCM from Sep.2006 to Nov.2011 in Children's Hospital Affiliated to Chongqing Medical University were randomly divided into carvedilol group [(24 cases,14 doys,10 girls; (3.05 ± 3.27) years old] and metoprolol group [(24 cases,13 boys,11 girls,(3.15 ± 2.42) years old].After controlling heart failure,the patients began to take oral carvedilol starting from 0.1 mg/(kg · d) or metoprolol starting from 0.5 mg/(kg · d).The 2 groups increased dose every 2 weeks.The largest dose was respectively 0.8 mg/(kg · d) or 2.0 mg/(kg · d),then maintaining the treatment for about 12 months.Cardiothoracic ratio,left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),left ventricular ejection fraction (LVEF),left ventricular shortening fraction(LVFS),left ventricular mass (LVmass),drug safety and tolerance of 2 groups after treatment were evaluated.Results Cardiothoracic ratio,LVEDV,LVESV,LVmass significantly decreased but LVEF,LVFS significantly increased after treatment in comparison with before treatment in carvedilol group and metoprolol group(all P ＜ 0.05).Heart size and function were of no significant differences between carvedilol group and metoprolol group before treatment and after treatment (all P ＞ 0.05).The tolerated dose and safety of drug was slightly higher in carvedilol group compared with metoprolol group,but they did not have statistically significant difference (P ＞ 0.05).Conclusions Both carvedilol and metoprolol can reverse left ventricular remodeling and improve cardiac function of children with DCM.Carvedilol and metoprolol have higher safety and better tolerance.Safety and tolerance of carvedilol may be better,and thus has better application prospect.