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2.
Arch. pediatr. Urug ; 92(2): e211, dic. 2021. tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1278304

ABSTRACT

Introducción: las cardiopatías congénitas (CC) son patologías frecuentes en pediatría. Son causa de importante morbimortalidad en la infancia. Son pacientes complejos, que requieren abordaje integral, en equipo interdisciplinario. Objetivos: describir las características epidemiológicas, clínicas y evolutivas de niños portadores de CC asistidos en la Unidad de Cardiología del HP-CHPR durante el año 2015, así como su estado nutricional y los factores que pudieran influir en este. Material y método: estudio descriptivo, retrospectivo, a través de la revisión de historias clínicas de pacientes portadores de CC, hospitalizados en la Unidad de Cardiología del HP-CHPR en 2015. Se describieron características epidemiológicas y clínicas de los pacientes. Resultados: en el período evaluado egresaron 63 pacientes, que representaron una tasa de 6,58/1.000 egresos hospitalarios. Tenían un promedio de edad de 23,8 meses. Un total de 8 pacientes fueron diagnosticados en el período prenatal, 54 presentaban CC no cianóticas. Habían sido sometidos a tratamiento quirúrgico 24 niños, 13 con cirugía correctiva. Se diagnosticó desnutrición en 43%. Esta fue más prevalente en portadores de CC cianótica, de defectos complejos, y de cromosomopatías u otras malformaciones. Conclusión: los niños con CC representaron un pequeño porcentaje de quienes requirieron hospitalización en el HP-CHPR. El porcentaje de desnutrición fue elevado. Este estudio confirma la importante morbimortalidad de los niños pequeños portadores de CC. Es importante reconocer el mayor riesgo de estos pacientes y actuar en forma individualizada y oportuna.


Introduction: congenital heart disease (CHD) is a frequent pathology among children. It may cause significant morbidity and mortality during childhood. These are complex patients, who require a comprehensive approach and an interdisciplinary team. Objective: to describe the epidemiological, clinical and evolutionary characteristics of children with CHD assisted in the Cardiology Department of the Children Hospital-CHPR in 2015. Material and Methods: descriptive, retrospective study, review of clinical records of patients with CHD, hospitalized in the Cardiology Department of the Children's Hospital PRHC in 2015. Epidemiological and clinical characteristics of patients were described. Results: 63 patients were hospitalized during the evaluated period, a total rate of 6.58/1.000 discharges. They had an average age of 23.8 months. Eight patients were diagnosed in the prenatal period, 54 presented non-cyanotic CHD. Twenty-four children had undergone surgical treatment, 13 had had corrective surgery. Malnutrition was diagnosed in 43% and it was more prevalent in cyanotic CHD carriers, complex defects, and chromosomopathies or other malformations. Conclusion: CHD represented a small percentage of the children who required hospitalization at the PH-PRHC. The percentage of malnutrition was high. The study confirmed the significant morbidity and mortality of these patients. It is important to recognize the highest risk of these patients and act in a customized and timely fashion.


Introdução: as cardiopatias congênitas (CC) são patologias comuns em pediatria. Elas são uma causa significativa de morbidade e mortalidade na infância. Os pacientes são complexos e requerem uma abordagem integral e uma equipe interdisciplinar. Objetivos: descrever as características epidemiológicas, clínicas e evolutivas de crianças com CC atendidas na Unidade de Cardiologia do Hospital Pediátrico PHPR durante o ano de 2015, descrever seu estado nutricional e os fatores que poderiam influenciá-lo. Material e métodos: estudo descritivo, retrospectivo, feito por meio da revisão de prontuários de pacientes com CC, internados na Unidade de Cardiologia do HP-CHPR em 2015. Foram descritas as características epidemiológicas e clínicas dos pacientes. Resultados: no período avaliado, 63 pacientes receberam alta hospitalar, representando uma taxa de 6,5/1.000 altas hospitalares. Eles tinham uma idade média de 23,8 meses. Oito pacientes foram diagnosticados no período pré-natal, 54 apresentavam CC não cianótica. 24 crianças tinham sido submetidas a tratamento cirúrgico, 13 tinham recebido cirurgia corretiva. 43% foram diagnosticadas com desnutrição, a qual foi mais prevalente em portadores de CC cianótica, defeitos complexos e malformações cromossômicas ou outras. Conclusão: os CCs representaram um pequeno percentual de crianças que necessitaram de internação no HP-CHPR. O percentual de desnutrição foi alto. Este estudo confirma a morbidade e mortalidade significativas de crianças pequenas com CC. É importante reconhecer o risco aumentado desses pacientes e agir de forma individualizada e oportuna.


Subject(s)
Humans , Male , Female , Pregnancy , Infant , Child, Preschool , Child , Adolescent , Malnutrition/complications , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/epidemiology , Hospitalization , Prenatal Diagnosis , Epidemiology, Descriptive , Retrospective Studies , Malnutrition/diagnosis , Malnutrition/epidemiology , Heart Defects, Congenital/surgery , Heart Defects, Congenital/classification
3.
Arch. cardiol. Méx ; 91(1): 34-41, ene.-mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1152858

ABSTRACT

Abstract Objective: The real burden of (congenital heart defects [CHD]) and the improvement after surgical correction or palliation is both reflected in the quality of life (QoL). There are few studies in Latin-America that evaluate QoL in the CHD population. The purpose of this study was to measure the QoL after corrective or palliative surgery for CHD. Materials and methods: An observational, cross-sectional, and comparative study was carried out at the Miguel Hidalgo Centennial Hospital. Patients from 8 to 18 years old who underwent surgery for CHD were included during a period of 8 months. A total of 40 patients were included, together with a group of 80 healthy controls. From all participants, a KIDSCREEN-52 questionnaire was taken. A comparative analysis of the results was performed. Results: Overall, patients with cardiac surgery had better QoL indexes than healthy controls (p < 0.0001). The difference was greatest in moods and emotions, autonomy, and parent relations. Conclusions: Self-perception of QoL in post-operative patients for congenital heart disease is similar and in certain dimensions higher than the healthy population, possibly due to socioeconomic differences, parental care, and styles of coping with their disease. Higher complexity studies that include psychosocial variables and parental perception are required, and a better understanding of the QoL determinants will improve the attention provided to the patient and their families.


Resumen Objetivo: Los efectos de las cardiopatías congénitas en los pacientes, así como la mejoría después de la paliación o la corrección quirúrgica, se reflejan en la calidad de vida (CV). Hay pocos estudios en Latinoamérica que evalúen la CV en esta población. El objetivo de este artículo es notificar la CV posterior a la operación paliativa o correctiva para defectos cardíacos congénitos. Material y métodos: Se llevó a cabo un estudio observacional, transversal y comparativo en el Centenario Hospital Miguel Hidalgo. Durante un período de ocho meses se incluyó a pacientes de 8 a 18 años sometidos a una intervención para cardiopatías congénitas. Se reunió a dos grupos de 40 pacientes y 80 controles sanos, pareados por edad y sexo. A cada participante se le aplicó el cuestionario KIDSCREEN-52 y se realizó un análisis comparativo de los resultados. Resultados: Los pacientes sometidos a operación cardíaca tuvieron mejores índices de CV que los controles sanos (p < 0.0001). La mayor diferencia se obtuvo en los aspectos de estado de ánimo y emociones, autonomía y relación con los padres. Conclusiones: La autopercepción de la CV después de una intervención para cardiopatías congénitas es similar y, en ciertas dimensiones, mejor que la de la población sana, tal vez por diferencias socioeconómicas, atención de los padres y modelos de adaptación a la enfermedad. Se requieren estudios más extensos que incluyan variables psicosociales y percepción parental. Una mayor comprensión de los determinantes de la CV podría mejorar la atención ofrecida al paciente y su familia.


Subject(s)
Humans , Male , Female , Child , Adolescent , Quality of Life , Heart Defects, Congenital/surgery , Cardiac Surgical Procedures , Cross-Sectional Studies , Cohort Studies , Mexico
4.
Arch. cardiol. Méx ; 91(1): 1-6, ene.-mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1152854

ABSTRACT

Resumen Introducción: Los defectos cardíacos congénitos constituyen el 30% de todas las anomalías congénitas. La prevalencia es de 8/1,000 recién nacidos vivos, sin predominio de género. Para una planificación quirúrgica óptima es esencial una evaluación precisa de la anatomía en los defectos cardíacos congénitos. Las modalidades de imagen como el ecocardiograma, la angiografía por cateterismo cardíaco, la tomografía computarizada (TC) o la resonancia magnética (RM) se utilizan de forma regular para el diagnóstico de las cardiopatías congénitas. Estos métodos pueden proporcionar reconstrucciones virtuales en reconstrucción volumétrica o 3D, pero no réplicas táctiles reales de la anatomía cardíaca. Objetivo: Realizar modelos de corazón impresos en 3D con la finalidad de proporcionar réplicas táctiles 3D reales de la anatomía cardíaca para visualizar de forma detallada todas las perspectivas posibles de las estructuras extracardíacas o intracardíacas. Métodos: Los datos de la imagen se obtuvieron en formato DICOM, se editaron en el paquete de software "3D slicer 4.3" y se exportaron para la impresión en formato de archivo (.stl). Resultados y conclusiones: Con la impresión 3D se puede evaluar de forma detallada la anatomía intracardíaca y extracardíaca con modelos cardíacos en tiempo real. Esta técnica es de gran utilidad, sobre todo en los defectos cardíacos congénitos complejos, ya que permite hacer una planificación precisa del procedimiento quirúrgico.


Abstract Introduction: Congenital heart disease makes up for 30% of all congenital anomalies. The prevalence is 8/1,000 live newborns, without predominance of gender. Imaging methods such as echocardiography, angiography, computed tomography or magnetic resonance imaging must be routinely used in congenital heart disease. The mentioned methods can provide virtual reconstructions in volumetric reconstruction or in three dimensional (3D), but only 3D-printed heart models can provide real 3D tactile replicas of cardiac anatomy. Objective: To make 3D printed heart models in order to provide real 3D tactile replicas of the cardiac anatomy that allow a detailed visualization from all possible perspectives, either of extracardiac or intracardiac structures. Methods: This information is useful for surgical decision making, especially in patients with complex cardiac defects. DICOM, edited in a software package "3D slicer 4.3" and exported for printing in file format (.stl). Results and conclusions: With 3D printing, the intracardiac and extracardiac anatomy can be evaluated in detail with real-scale cardiac models of the patient, avoiding unexpected findings. This technique is very useful especially in complex congenital heart defects, since it allows precise planning of the surgical procedure.


Subject(s)
Humans , Male , Female , Infant , Child , Adolescent , Patient Care Planning , Printing, Three-Dimensional , Heart Defects, Congenital/surgery , Models, Anatomic
5.
Audiol., Commun. res ; 26: e2370, 2021. tab
Article in Portuguese | LILACS | ID: biblio-1249003

ABSTRACT

RESUMO Objetivo Identificar os marcadores clínicos associados às alterações da deglutição em crianças após a correção da doença cardíaca congênita e correlacionar esses marcadores às categorias da escala Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1). Métodos Foi realizado um estudo retrospectivo observacional, utilizando a base de dados eletrônica do centro de pediatria para crianças admitidas em um hospital, em decorrência de doença cardíaca congênita. Foram coletados dados da avaliação de deglutição e a presença de disfagia foi classificada de acordo com a Dysphagia Management Staging Scale (DMMS). Foram incluídos os dados demográficos, os marcadores clínicos e o risco de mortalidade, de acordo com a RACHS-1. Resultados A amostra final do estudo foi composta por 108 pacientes. Os achados mais relevantes foram: os sinais mais graves de disfagia estiveram associados ao aumento da permanência no hospital (p=0,005); ao maior número e tempo de intubações orotraqueais (p=0,022 e 0,005, respectivamente); ao maior tempo entre a admissão hospitalar e a avaliação da deglutição (p=0,003); ao maior tempo entre o procedimento cirúrgico e a avaliação da deglutição (p=0,043) e ao maior número de sessões fonoaudiológicas para remoção da via alternativa de alimentação e retorno seguro para via oral (p<0,001). Não foram encontradas correlações entre o risco de mortalidade das crianças e os sinais alterados na avaliação da deglutição. Conclusão Os resultados do estudo contribuem para o conhecimento atual de que crianças com doenças cardíacas que precisam de correção cirúrgica apresentam dificuldades alimentares e necessitam atendimento hospitalar prolongado. Não houve correlação entre as categorias da escala RACHS-1 e os sinais de alteração na avaliação clínica da deglutição.


ABSTRACT Purpose To identify clinical markers that are associated to swallowing alterations in infants after surgical repair of congenital heart disease (CHD) and to correlate these markers to the categories on the Risk Adjustment for Congenital Heart Disease 1 (RACHS-1) scale. Methods Using the Pediatric Center Database System we conducted a retrospective, observational cohort study on children admitted to the pediatric hospital unit due to CDH. We collected data on specific parameters of a clinical swallowing assessment (SA) and dysphagia was classified according to the Dysphagia Management Staging Scale. We also included demographic and clinical markers and patient´s risk of mortality was determined by using the RACHS-1. Results The final study sample consisted of 108 patients. Important findings were: the more severe signs of dysphagia are associated to an increased length of hospital stay (p=0.005); an increased number and duration of orotracheal intubation (p=0.022 and 0.005 respectively); an increased time between hospital admission and SA (p=0.003); an increased time between the surgical procedure and swallowing assessment (0.043); and an increased number of SLP sessions to remove alternate feeding methods and warrant safe oral feeding (p<0.001). No correlations were observed between the infant's risk of mortality and the altered sings on the clinical swallowing assessment. Conclusion The data from this study contributes to the current knowledge that children with heart condition requiring heart surgery in the first month of life have high risk of presenting feeding difficulties and will require prolonged hospital care. No correlation was observed between the categories on RACHS-1 and the altered signs on the clinical swallowing assessment.


Subject(s)
Humans , Infant, Newborn , Infant , Deglutition Disorders , Risk Adjustment , Heart Defects, Congenital/surgery , Heart Defects, Congenital/complications , Postoperative Care , Brazil , Cohort Studies , Enteral Nutrition , Speech, Language and Hearing Sciences
8.
Braz. j. med. biol. res ; 54(9): e10220, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249341

ABSTRACT

Necrotizing enterocolitis (NEC) is a common condition in preterm infants. The risk factors that contribute to NEC include asphyxia, apnea, hypotension, sepsis, and congenital heart diseases (CHD). The objective of this study was to evaluate the association between the treatment (surgery or drainage) and unfavorable outcomes in neonates with NEC and congenital heart diseases (NEC+CHD). A 19-year retrospective cohort study was conducted (2000-2019). Inclusion criterion was NEC Bell II stage. Exclusion criteria were associated malformation or genetic syndrome and those who did not undergo echocardiography or had a Bell I diagnosis. We included 100 neonates: NEC (n=52) and NEC+CHD (n=48). The groups were subdivided into NEC patients undergoing surgery (NECS, n=31), NEC patients undergoing peritoneal drainage (NECD, n=19), NEC+CHD patients undergoing surgery (NECCAS, n=21), and NEC+CHD patients who were drained (NECCAD, n=29). Multivariate analysis was performed to estimate the relative risk of death and the length of stay. Covariates were birth weight and gestational age. The group characteristics were similar. The adjusted relative risk of death was higher in the drainage groups [NECD (Adj RR=2.70 (95%CI: 1.47; 4.97) and NECCAD (Adj RR=1.97 (95%CI: 1.08; 3.61)], and they had the shortest time to death: NECD=8.72 (95%CI: 3.10; 24.54) and NECCAD=5.32 (95%CI: 1.95; 14.44). We concluded that performing primary peritoneal drainage in neonates with or without CHD did not improve the number of days of life, did not decrease the risk of death, and was associated with a higher mortality in newborns with NEC and clinical instability.


Subject(s)
Humans , Infant, Newborn , Infant , Enterocolitis, Necrotizing/complications , Heart Defects, Congenital/surgery , Heart Defects, Congenital/complications , Brazil/epidemiology , Infant, Premature , Retrospective Studies
9.
Article in Chinese | WPRIM | ID: wpr-879813

ABSTRACT

OBJECTIVE@#To study the effect of calorie-enriched formula on postoperative catch-up growth in infants with cyanotic congenital heart disease (CHD).@*METHODS@#A total of 100 infants with cyanotic CHD who underwent surgical operation from January to December, 2017, were randomly divided into a high-calorie group (receiving calorie-enriched formula after surgery) and a conventional group (receiving standard formula after surgery), with 50 infants in each group. All infants were followed up for 6 months. The observation indices included body height, body weight, prealbumin, and N-terminal pro-brain natriuretic peptide before surgery, at the time of ventilator weaning and extubation after surgery, and at 1, 3, and 6 months after surgery. Height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and weight-for-height Z-score (WHZ) were also assessed. Adverse reactions were recorded for both groups.@*RESULTS@#There were 25 cases (50%) and 21 cases (42%) of malnutrition in the high-calorie group and the conventional group respectively before surgery (@*CONCLUSIONS@#Compared with the standard formula, calorie-enriched formula can better help with postoperative catch-up growth in infants with cyanotic CHD.


Subject(s)
Body Weight , Energy Intake , Heart Defects, Congenital/surgery , Humans , Infant , Malnutrition , Nutritional Status , Prospective Studies
10.
Med. infant ; 27(2): 145-151, Diciembre 2020. ilus, Tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1150455

ABSTRACT

Introducción: La ventilación mecánica (VM) forma parte de la recuperación postoperatoria (PO) de niños con cirugía de cardiopatía congénita, pero su uso no está exento de riesgos. El fracaso de extubación (FE) se ha asociado con internaciones prolongadas, aumento de complicaciones y mortalidad. El objetivo es determinar un valor de Vd/Vt predictor de extubación exitosa (EE). Material y métodos: estudio de cohorte prospectivo y observacional realizado del 1 de Enero al 31 de Diciembre de 2016 en niños menores de 6 meses cursando PO de cirugía cardiovascular con circulación extracorpórea (CEC) con requerimientos de VM por más de 48 horas. En los mismo se analizó el éxito o fracaso de extubación. Previo a la extubación se registraron valores de mecánica respiratoria; Vd/Vt, CO2 espiratoria final, Vt/kg, etc. Otras variables registradas: edad, sexo, peso, requerimiento de VM antes de la cirugía, fisiología de ventrículo único, duración de VM, complicaciones, duración de la internación y mortalidad. Las variables continuas se describieron como mediana y rango intercuartilo (25-75) y se compararon con prueba de Wilcoxon, las categóricas como proporciones o porcentajes y se analizaron con chi2 . Se efectuó un análisis bivariado con diferentes puntos de corte de Vd/Vt pre extubación para realizar un análisis de sensibilidad del valor predictivo de EE. Resultados: Se evaluó Vd/Vt en 67 pacientes, tres se eliminaron por parálisis cordal (1) y parálisis del diafragma (2). Mediana de edad 23 días (10-55), peso 3.2 Kg (2.89- 3.88), días de VM 5 (3-7), días de internación 15 (2- 128), mortalidad 7,8%. Se extubaron con éxito 76% de los pacientes (50/64). Las características demográficas de los pacientes, la mecánica respiratoria, gases de sangre arterial y EtCO2 no tuvieron asociación significativa con EE. Un Vd/Vt pre extubación < 0,53 se asoció con EE. Conclusión: En la población estudiada un valor de Vd/Vt <0,53 se asoció con EE. Los pacientes con ventrículo único presentaron mayor FE.(AU)


Introduction: Mechanical ventilation (MV) is part of postoperative (PO) recovery of children with congenital heart disease surgery, but is not without risks. Extubation failure (EF) has been associated with prolonged hospital stays and increased complication and mortality rates. The goal is to determine the value of Vd/Vt as a predictor of successful extubation (SE). Material and methods: A prospective and observational cohort study was conducted from January 1 to December 31, 2016, in children under 6 months of age undergoing cardiovascular surgery with extracorporeal circulation (ECC) and requiring MV for more than 48 hours. Intubation success or failure was evaluated. Prior to extubation, respiratory mechanics values, such as Vd/Vt, final expiratory CO2, and Vt/kg, were recorded. Other variables, including age, sex, weight, VM requirement before surgery, single ventricle physiology, VM duration, complications, length of hospital stay, and mortality were also recorded. Continuous variables were described as median and interquartile range (25-75) and compared with the Wilcoxon test. Categorical variables were described as proportions or percentages and analyzed with chi2. Bivariate analysis was performed with different pre-extubation Vd/Vt cut-off points to analyze the sensitivity of the predictive value for SE. Results: Vd/Vt was evaluated in 67 patients; three were excluded because of vocal fold (1) and diaphragm paralysis (2). Median age was 23 days (10-55), weight 3.2 Kg (2.89- 3.88), days on MV 5 (3-7), length of hospital stay 15 (2- 128), and mortality rate 7.8%. Overall, 76% of patients (50/64) were successfully extubated. Patient demographics, respiratory mechanics, arterial blood gases, and EtCO2 were not significantly associated with SE. A pre-extubation Vd/ Vt < 0.53 was associated with SE. Conclusion: In this series of patients, a Vd/Vt value of <0.53 was associated with SE. EF was increased in patients with a single ventricle (AU)


Subject(s)
Humans , Infant, Newborn , Infant , Respiration, Artificial , Respiratory Dead Space/physiology , Tidal Volume/physiology , Airway Extubation , Heart Defects, Congenital/surgery , Postoperative Complications , Prospective Studies , Cohort Studies , Critical Care
12.
Rev. cuba. pediatr ; 92(3): e752, jul.-set. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126773

ABSTRACT

Introducción: La colocación de stents mediante cateterismo cardiaco en recién nacidos con ciertas cardiopatías congénitas complejas constituye un puente hacia la cirugía correctiva, paliativa o trasplante cardiaco. Objetivo: Evaluar el resultado del implante percutáneo de stents en pacientes recién nacidos con cardiopatías congénitas complejas. Presentación de los casos: Se colocó stents en cinco pacientes; a uno de ellos en la aorta y a los cuatros restantes en el ductus arterioso. Un primer paciente con hipoplasia de cavidades izquierdas en el que predominaba el bajo gasto se le colocó stent en el ductus e inmediatamente se le condujo al salón de operaciones para cerclaje pulmonar. Otro paciente con la misma enfermedad, pero en el que predominaba el hiperflujo pulmonar, se intervino de forma inversa, medió 47 días entre uno y otro proceder. A un tercer paciente, portador de coartación aórtica, se le colocó stent en la aorta y se le hizo cerclaje pulmonar 14 días después del proceder hemodinámico. Las condiciones clínicas del cuarto paciente, con síndrome de hipoplasia de cavidades izquierdas solo permitió colocar stent en el ductus. Esta paciente fallece en evento no relacionado con el cateterismo cardiaco. El último paciente intervenido, portador de una atresia pulmonar, tolera la colocación del stent en el ductus y la evolución clínica posterior demostró que no requería realizar cerclaje pulmonar. Conclusiones: La colocación de stent en el grupo de pacientes analizado es factible y el momento de su implante según el evento hemodinámico apremiante pudiera ser una forma alternativa del cateterismo cardiaco(AU)


Introduction: The paliative placing of stents by cardiac catetherism in new borns with specific congenital hearts diseases is a bridge through a new kind of corrective, paliative surgery or heart transplant. Objective: To evaluate the result of the percutaneous implant of stents in newborn patients with complex congenital heart diseases. Cases presentation: There were placed stents in 5 patients, to one of them in the aorta and to the other four in the ductus arteriosus. The first patient with hypoplasia of the left cavities in which low output predominated had an stent placing in the ductus and he was immediately taken to OR to perform a pulmonary cerclage. Another patients with the same disease but with predominance of pulmonary hyperflow was intervened in the inverse way; there were 47 days between both procedures. A third patient, carrier of aortic coarctation, had an stent placing in the aorta and he also had pulmonary cerclage 14 days after the hemodynamic procedure. The clinical conditions of the fourth patient, who had syndrome of left cavities´ hypoplasia, just allowed to place the stent in the ductus. This patients died in a procedure not related to heart catetherism. The last intervened patient, who was a carrier of pulmonary atresia, tolerated the stent placing in the ductus and the subsequent clinical evolution showed that it was not needed pulmonary cerclage. Conclusions: The stent placing in the analized group of patients is suitable and the moment for its implantation according to the hemodynamic event can be an alternative form of heart catetherism(AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Cardiac Catheterization/methods , Stents/standards , Heart Defects, Congenital/surgery
13.
Rev. bras. anestesiol ; 70(3): 278-287, May-June 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137180

ABSTRACT

Abstract Background: Several interventional cardiology procedures are required in neonates with congenital heart disease. Interventional cardiology procedures have a higher risk of cardiac arrest compared to other interventions. At present, there is great heterogeneity in the perioperative management of congenital heart disease neonates undergoing diagnostic cardiac catheterization or therapeutic cardiac catheterization. Study objectives: Primary aim: Provide a systematic review of the most effective and/or safe anesthetic and perioperative management in neonates with congenital heart disease who undergo diagnostic cardiac catheterization or therapeutic cardiac catheterization. Secondary aim: Identify the medications, monitoring parameters and airway management used in the same population. Design: Systematic literature review. Setting: Catheterization laboratory. Methods: Literature was searched (December 2017) in electronic databases Medline, EMBASE, ScienceDirect, BIREME-Lilacs-Biblioteca Virtual de la Salud, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment Database. Main results: From 130 records identified, four studies met inclusion criteria and quality assessment. None of the studies were relevant to the primary objective. Regarding the secondary objectives, one study compared the efficacy and adverse effects of racemic ketamine and its S(+) ketamine enantiomer, one study reported the efficacy of subarachnoid anesthesia for high-risk children undergoing diagnostic cardiac catheterization, one study identified the factors associated to high severity adverse events related to sedation, anesthesia and airway, and one study retrospectively analyzed cardiac catheterization procedures in neonates weighing less than 2.5 kg. Conclusion: There are no evidence-based recommendations available for congenital heart disease neonates undergoing cardiac catheterization. More studies are required to evaluate the ideal anesthetic and perioperative management in this population.


Resumo Introdução: Vários procedimentos de cardiologia intervencionista são necessários em neonatos com doença cardíaca congênita. Os procedimentos de cardiologia intervencionista têm um risco maior de parada cardíaca em comparação com outras intervenções. Atualmente, há grande heterogeneidade no manejo perioperatório de neonatos com doença cardíaca congênita submetidos a cateterismo cardíaco diagnóstico ou cateterismo cardíaco terapêutico. Objetivo: Objetivo principal: fornecer uma revisão sistemática do manejo anestésico e perioperatório mais efetivo e/ou seguro em neonatos com doença cardíaca congênita submetidos à cateterismo cardíaco diagnóstico ou cateterismo cardíaco terapêutico. Objetivo secundário: Identificar os medicamentos usados, parâmetros monitorizados e manejo das vias aéreas utilizado na população estudada. Desenho: Revisão sistemática da literatura. Local: Laboratório de hemodinâmica e cateterismo cardíaco. Método: Foi realizada busca na literatura (Dezembro de 2017) nos seguintes bancos de dados eletrônicos: Medline, EMBASE, ScienceDirect, BIREME-Lilacs-Biblioteca Virtual de la Salud, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects e Health Technology Assessment Database. Resultados principais: Dos 130 registros identificados, quatro estudos obedeceram aos critérios de inclusão e de avaliação de qualidade. Nenhum dos estudos foi relevante para o objetivo principal. Em relação aos objetivos secundários, um estudo comparou a eficácia e os efeitos adversos da cetamina racêmica e seu enantiômero S(+) cetamina, um estudo relatou a eficácia da anestesia subaracnóidea em crianças de alto risco submetidas ao cateterismo cardíaco diagnóstico, um estudo identificou os fatores associados à maior gravidade de eventos adversos relacionados à sedação, anestesia e vias aéreas, e um estudo analisou retrospectivamente os procedimentos de cateterismo cardíaco em neonatos com peso inferior a 2,5 kg. Conclusão: Não há recomendações com base em evidências disponíveis para neonatos com doença cardíaca congênita submetidos a cateterismo cardíaco. Mais estudos são necessários para avaliar o manejo anestésico e perioperatório ideal nessa população.


Subject(s)
Humans , Infant, Newborn , Cardiac Catheterization , Heart Defects, Congenital/surgery , Heart Defects, Congenital/diagnosis , Anesthesia/standards
15.
Rev. bras. ter. intensiva ; 32(2): 261-267, Apr.-June 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138498

ABSTRACT

RESUMO Objetivo: Avaliar a funcionalidade de pacientes pediátricos submetidos à correção cirúrgica de cardiopatia congênita após a alta da unidade de terapia intensiva e as possíveis correlações com variáveis clínicas e risco cirúrgico. Métodos: Estudo transversal, que incluiu crianças entre 1 mês e 18 anos incompletos, que realizaram cirurgia para correção de cardiopatia congênita, no período de outubro de 2017 até maio de 2018. A avaliação da funcionalidade foi realizada por meio da Functional Status Scale, a avaliação do risco cirúrgico se deu pelo Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), e as variáveis clínicas foram obtidas do prontuário eletrônico. Resultados: A amostra foi composta de 57 crianças, com mediana de idade de 7 (2 - 17) meses, sendo 54,4% do sexo masculino. Dentre as crianças, 75,5% apresentaram alteração na funcionalidade, e 45,6% delas tiveram disfunção moderada. Cerca de 47% da amostra apresentou classificação RACHS-1 > 3, indicando maior risco cirúrgico. Maior déficit funcional foi associado a crianças mais novas, com maior duração da ventilação mecânica invasiva e do tempo de internação na unidade de terapia intensiva. Além disso, maior grau de disfunção foi observado entre aqueles classificados com RACHS-1 > 3. Conclusão: A prevalência de disfunção foi elevada em crianças e adolescentes com cardiopatia após cirurgia cardíaca. Maior risco cirúrgico, duração da ventilação mecânica invasiva, permanência na unidade de terapia intensiva e os mais jovens apresentaram associação com pior desempenho funcional.


Abstract Objective: To evaluate the functional status of pediatric patients undergoing congenital heart surgery after discharge from the intensive care unit, and to evaluate the correlations among clinical variables, functional status and surgical risk. Methods: Cross-sectional study including patients aged 1 month to less than 18 years undergoing congenital heart surgery between October 2017 and May 2018. Functional outcome was assessed by the Functional Status Scale, surgical risk classification was determined using the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and clinical variables were collected from electronic medical records. Results: The sample comprised 57 patients with a median age of 7 months (2 - 17); 54.4% were male, and 75.5% showed dysfunction, which was moderate in 45.6% of the cases. RACHS-1 category > 3 was observed in 47% of the sample, indicating higher surgical risk. There was a correlation between functional deficit and younger age, longer duration of invasive mechanical ventilation and longer intensive care unit stay. Moreover, greater functional deficit was observed among patients classified as RACHS-1 category > 3. Conclusion: The prevalence of functional deficit was high among children and adolescents with congenital heart disease after cardiac surgery. Higher surgical risk, longer duration of invasive mechanical ventilation, longer intensive care unit stay and younger age were correlated with worse functional status.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Respiration, Artificial/statistics & numerical data , Heart Defects, Congenital/surgery , Cardiac Surgical Procedures/methods , Intensive Care Units , Patient Discharge , Time Factors , Cross-Sectional Studies , Risk Factors , Age Factors , Functional Status , Length of Stay
16.
Arch. argent. pediatr ; 118(3): 166-172, jun. 2020. ilus, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1102720

ABSTRACT

Introducción. En las últimas décadas, el desarrollo de métodos diagnósticos, técnicas quirúrgicas y cuidados intensivos, aumentó la sobrevida de los niños con cardiopatía congénita. En este contexto, las secuelas a largo plazo adquirieron mayor relevancia. La calidad de vida relacionada con la salud mide el impacto de las enfermedades crónicas. Nuestro objetivo fue describir la calidad de vida relacionada con la salud en pacientes con cardiopatía congénita operados durante el primer año de vida.Población y métodos. Estudio observacional, transversal, realizado entre agosto de 2017 y diciembre de 2018 en un hospital general universitario. Se utilizó el cuestionario PedsQL 4.0, versión genérica. Se incluyeron pacientes de entre 2 y 4 años con cardiopatía congénita operados durante el primer año de vida y niños sanos. Se compararon los resultados con T-Test o Wilcoxon según la distribución observada. Se consideró significativo el valor de p < 0,05.Resultados. Se incluyeron 31 pacientes. El 26 % tenían ventrículo único. La primera cirugía fue, en un 61,3 %, en el período neonatal. No hubo diferencia (p = 0,10) entre la calidad de vida relacionada con la salud global de la población con cardiopatía congénita y de los niños sanos. Sin embargo, se observaron puntajes más bajos con diferencia estadísticamente significativa en las esferas social (p = 0,0092) y escolar (p = 0,0001).Conclusiones. Nuestra cohorte de niños con cardiopatía congénita tiene una calidad de vida global comparable con la de los niños sanos, excepto en las escalas correspondientes a funcionamiento social y escolar.


Introduction. Advances in diagnostic methods, surgical techniques and postoperative intensive care have significantly increased the survival rates for children with congenital heart disease.In this context, long term sequelae acquired greater relevance. Health-related quality of life (HRQOL) is a concept that helps to measure the impact of chronic diseases.The purpose of the current study was to describe HRQOL in children with congenital heart disease that undergo cardiac surgery during their first year of life.Methods. A cross-sectional observational study was conducted between August 2017 and December 2018 at a University General Hospital. PedsQL 4.0 Generic Core Scales were used.Children with congenital heart disease between 2 and 4 years old who had cardiac surgery during their first year of life and healthy children were included.Scores were compared with T-test or Wilcoxon according to the observed distribution. p value < 0.05 was considered significant.Results. A total of 31 children with congenital heart disease (26 % with a single ventricle) and 62 healthy children were enrolled. The first surgery was in the neonatal period in 61.3 %.Our study showed no statistical differences (p = 0.10) between HRQOL Total Scale Score of children with congenital heart disease compared to healthy children. However, lower scores were observed with statistically significant differences in social (p = 0.0092) and school (p = 0.0001) scales.Conclusions. Our cohort of children diagnosed with congenital heart disease has a global quality of life comparable with healthy children except in social and school functioning scales.


Subject(s)
Humans , Male , Female , Child, Preschool , Quality of Life , Heart Defects, Congenital/surgery , Chronic Disease , Cross-Sectional Studies , Surveys and Questionnaires , Heart Defects, Congenital/diagnosis , Cardiac Surgical Procedures
17.
Arch. argent. pediatr ; 118(3): 173-179, jun. 2020. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1102723

ABSTRACT

La hernia diafragmática congénita (HDC) es una enfermedad de baja prevalencia, con elevada morbimortalidad. Los factores pronósticos posnatales, durante el primer día de vida, son útiles para la toma de decisiones.Objetivos. Determinar la capacidad predictiva de los factores posnatales ecocardiográficos, clínicos y bioquímicos de mortalidad en los recién nacidos con HDC durante el primer día de vida.Método. Estudio observacional analítico de cohorte retrospectiva. Se incluyeron los pacientes con HDC, en forma consecutiva, desde marzo de 2012 a noviembre de 2018. Se analizaron como predictores el índice de oxigenación (IO), valor más alto de presión parcial de dióxido de carbono en sangre (pCO2), puntaje de gravedad SNAPPE II, ecocardiograma, dosaje de NT-pro péptido natriurético B (NT-proPNB), todos medidos en el primer día de vida.Resultados. La población fue de 178 pacientes con HDC. La sobrevida, del 75 %. El 24 % recibió oxigenación por membrana extracorpórea. La presencia precoz de hipertensión pulmonar sistémica o suprasistémica no mostró capacidad predictiva (OR 2,2; IC 95 %: 0,8-8), p = 0,1. NT-proPNB tampoco mostró buena discriminación (área bajo la curva (ABC) 0,46, p = 0,67). El IO, SNAPPE II y el valor más alto de pCO2 mostraron buena discriminación, ABC IO 0,82, ABC SNAPPE II 0,86 y ABC pCO2 0,75, p < 0,001.Conclusión.SNAPPE II, IO y valor más alto de pCO2, medidos el primer día de vida, mostraron buena capacidad predictiva con respecto a la evolución; SNAPPE II fue superior al IO y al valor más alto de CO2.


Introduction: Congenital diaphragmatic hernia (CDH) prevalence is low while its associated morbidity and mortality rates are high. Postnatal prognostic factors on the first day of life are useful for predicting the outcome. Objectives: To determine the mortality predictive ability of postnatal echocardiographic, clinical, and biochemical factors among newborn infants with CDH in their first day of life. Method: Observational analytical study of a retrospective cohort. Patients with CDH were consecutively included between March 2012 and November 2018. On the first day of life, analyzed predictors were the oxygenation index (OI), the highest partial pressure of carbon dioxide (pCO2) level in blood, the SNAPPE II severity score, the echocardiography, and the N-terminal pro-B-type natriuretic peptide (NTproBNP) value. Results: The population consisted of 178 patients with CDH. Survival was 75 %. Extracorporeal membrane oxygenation was used in 24 %. The early onset of systemic or suprasystemic pulmonary hypertension showed no predictive ability (OR: 2.2, 95 % CI: 0.8-8), p = 0.1. NT-proBNP did not show good discrimination either (area under the curve [AUC]: 0.46, p = 0.67). The OI, SNAPPE II score, and the highest pCO2 level showed adequate discrimination power, AUC for OI: 0.82, AUC for SNAPPE II: 0.86, and AUC for pCO2: 0.75, p < 0.001. Conclusion: The SNAPPE II score, the OI, and the highest pCO2 level measured on the first day of life, showed a good predictive ability in terms of the course of the disease; the SNAPPE II score was better than the OI and the highest pCO2 level.


Subject(s)
Humans , Male , Female , Infant, Newborn , Hernias, Diaphragmatic, Congenital/mortality , Infant Mortality , Retrospective Studies , Risk Factors , Heart Defects, Congenital/surgery , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnostic imaging , Hernia, Diaphragmatic/diagnostic imaging
18.
Gac. méd. Méx ; 156(2): 110-117, mar.-abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1249880

ABSTRACT

Resumen Introducción: La cirugía de cardiopatías congénitas puede generar alteraciones perfusorias cerebrales con repercusión neurológica. Objetivo: Analizar la relación del índice de resistencia (IR) vascular cerebral periquirúrgico con funciones neurológicas mediatas posteriores a cirugía de cardiopatía congénita. Método: Estudio de cohorte prospectivo de 34 neonatos en quienes se determinó IR de la arteria basilar, niveles séricos de oxígeno, dióxido de carbono y lactato, antes y después de procedimientos paliativos o correctivos. Relacionamos el IR prequirúrgico con la capacidad posquirúrgica para iniciar la vía enteral o restablecer la respiración espontánea no asistida. Resultados: Se integraron tres grupos: 17 neonatos con IR alto > 0.73, cinco con IR normal de 0.63 a 0.73 y seis con IR bajo < 0.63. En los primeros persistió IR alto en el posquirúrgico, con hiperlactatemia e hipoxia persistentes; en 86 % no se logró iniciar la vía enteral ni retirar la ventilación asistida. En los segundos, el IR se mantuvo en valores normales. En los terceros, si bien el IR, el lactato sérico y la presión arterial de oxígeno tendieron a normalizarse, 71 % presentó daño neurológico grave. Conclusiones: Los cambios en el IR fueron frecuentes, aunque el daño neurológico parece presentarse más cuando el IR se mantiene alto, posiblemente asociado a flujos cerebrales bajos.


Abstract Introduction: Surgery for congenital heart disease can generate cerebral perfusion-associated alterations with neurological repercussions. Objective: To analyze the relationship of peri-surgical cerebrovascular resistance index (RI) with mediate neurological functions after congenital heart disease surgery. Method: Prospective cohort study of 34 neonates in whom basilar artery RI, serum oxygen, carbon dioxide and lactate levels were determined before and after palliative or corrective procedures. We related pre-surgical RI with post-surgical ability to initiate the enteral route or to restore unassisted spontaneous breathing. Results: Three groups were formed: 17 neonates with high RI (> 0.73), five with normal RI (0.63-0.73) and six with low RI (< 0.63). In the former group, high RI persisted in the postoperative period, with persistent hyperlactatemia and hypoxia; in 86%, the enteral route could not be initiated, and neither could assisted ventilation be withdrawn. In the second group, IR remained within normal values. In the third group, although RI, serum lactate and arterial oxygen pressure tended to normalize, 71% had severe neurological damage. Conclusions: RI changes were common, although neurological damage appears to occur more commonly when RI remains high, possibly associated with low cerebral blood flow.


Subject(s)
Humans , Infant, Newborn , Brain/blood supply , Heart Defects, Congenital/surgery , Cerebrovascular Circulation , Prospective Studies , Hyperlactatemia , Hypoxia
19.
Más Vita ; 2(1): 29-37, mar 2020. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1283722

ABSTRACT

Resaltar aspectos estratégicos del abordaje respiratorio radica en la prevención de factores de riesgo que eviten a gran escala secuelas crónicas ligadas a co-morbi mortalidad siendo este una problemática de Salud Pública en el Ecuador. Objetivos: Determinar los principales factores frecuente que inciden en el riesgo de las áreas de recuperación post quirúrgica. Métodos: La presente investigación de rasgo cuali-cuantitativo, no experimental, espectro transversal, y característica descriptiva, exploratoria con recolección de datos del historial clínico de hospital de referencia público nacional (MSP-HFIB), en instrumento diseñado y evaluado por expertos para posterior procesamiento estadístico, de población y muestra en 133 pacientes intervenidos. Resultados: el procesamiento con pruebas de Chi cuadrado de sus variables con identificación estadística de factores relevantes, como el predominio de casos del género masculino con 70 pacientes conformando el 52,6%, sobre 63 pacientes femeninos que constituye un 47,4%, otra notable relación fue: edad, días de ventilación mecánica/vía aérea artificial, observación al estado de alta médica. Identificó que, en menores edades con diagnóstico e intervención ejecutadas, con soportes y procedimientos críticos durante menor tiempo (Transquirúrgico - 16 horas o menos), aumentó la tendencia que aleja la predisposición de adquirir otras patologías. Conclusiones: Se observó beneficios y proporcionalidad de la aplicación de estrategias continuas y actualizadas en su abordaje, destacando conservar la protección del aspecto neurológico-respiratorio mitigando efectos colaterales modificables, que restringe la proyección de su autonomía y calidad de vida de los pacientes intervenidos(AU)


Highlighting strategic aspects of the respiratory approach lies in the prevention of risk factors that avoid chronic sequelae linked to co-morbi mortality on a large scale, this being a Public Health problem in Ecuador. Objective: To determine the main frequent factors that affect the risk of post-surgical recovery areas. Methods: The present investigation is a qualitative-quantitative, non-experimental, transversal spectrum, and descriptive characteristic exploratory. With a data collection of the national public reference hospital (MSP-HFIB). An instrument designed and evaluated by experts for later Statistical, population and sample processing in 133 operated patients. Results: The processing with Chi-square tests of its variables with statistical identification of relevant factors, such as the prevalence of male cases with 70 patients, making up 52.6%, over 63 female patients, which constitutes 47.4%. Another Remarkable relationship was: age, days of mechanical ventilation / artificial airway, observation of medical discharge status, identifying that in younger ages with diagnosis and intervention performed, with supports and critical procedures for a shorter time (Transsurgical - 16 hours or less ), increased the tendency that moves away the predisposition to acquire morbid mortality. Conclusions: Benefits and proportionality of the application of continuous and updated strategies in its approach were observed, highlighting the protection of the neurological-respiratory aspect. Application and monitoring that mitigates modifiable side effects, which restricts the projection of their autonomy and quality of life of the operated patients(AU)


Subject(s)
Humans , Male , Female , Aged , Respiratory System , Heart Disease Risk Factors , Heart Defects, Congenital/surgery , Respiration, Artificial , Intubation, Intratracheal
20.
Med. infant ; 27(1): 10-16, Marzo de 2020. tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1118522

ABSTRACT

El objetivo de este trabajo fue la evaluación funcional del neurodesarrollo de niños que requirieron terapias complejas neonatales entre los 24 y 30 meses de vida. Se incluyeron 104 pacientes evaluados en el Servicio de Clínicas Interdisciplinarias del Neurodesarrollo del Hospital de Pediatría Juan P. Garrahan, mediante pruebas estandarizadas; cuestionarios auto administrados y datos extraídos del interrogatorio, el examen físico y la historia clínica. A partir de los mismos los pacientes fueron agrupados según el grado de compromiso de su funcionalidad en dos grupos: el primero sin compromiso o compromiso leve y el segundo con compromiso moderado o severo. La evaluación funcional intenta desde una perspectiva biopsicosocial evaluar las habilidades, las dificultades y las características del entorno, que pueden ser tanto facilitadores como barreras para el desarrollo de la persona. De esta manera, permite un abordaje holístico del paciente y muestra como gran fortaleza frente a los diagnósticos categórico y etiológico, la adecuación de los sistemas de apoyos necesarios para cada paciente particular. En concordancia con la bibliografía sobre el riesgo biológico aumentado de esta población, el 44.2% de los niños de la muestra se encontraron dentro del grupo con compromiso funcional moderado/severo. En el análisis univariado las variables que presentaron asociación significativa con el grado de severidad del funcionamiento fueron la prematurez extrema, la displasia broncopulmonar, las lesiones en las ecografías cerebrales neonatales, internaciones neonatales prolongadas y los síndromes genéticos. Entre los factores medio-ambientales, se encontró asociación con progenitor solo y necesidad básicas insatisfechas (AU)


The aim of this study was the functional assessment of the neurodevelopment of children who require complex neonatal interventions between 24 and 30 months of life. Overall, 104 patients were evaluated at the Department of Interdisciplinary Clinics of Neurodevelopment at Hospital de Pediatría Juan P. Garrahan, with standardized tests, self-administered questionnaires and data gleaned from the interview, physical examination, and clinical records. Based on these data, the patients were divided into two groups according to the degree of functional involvement: a first group without or with mild functional compromise and a second group with moderate or severe compromise. From a biopsychosocial perspective, the purpose of functional assessment is the evaluation of skills, difficulties, and environmental characteristics that may be either facilitators or barriers to personal development. Thereby the assessment allows for a holistic approach of the patient and, unlike categorical and etiologic diagnosis, may lead to the adequate selection of the necessary support systems for each individual patient. In agreement with the literature on the increased biological risk in this population, 44.2% of the children in this sample were in the moderate/severe functional compromise group. In univariate analysis, the variables that were statistically significantly associated with degree of severity of function were extreme prematurity, bronchopulmonary dysplasia, lesion on neonatal ultrasonography, prolonged neonatal hospitalization, and genetic syndromes. Among environmental factors a significant association was found with a single parent and unsatisfied basic needs (AU)


Subject(s)
Humans , Child, Preschool , Psychomotor Disorders/diagnosis , Child Development , Developmental Disabilities , Premature Birth , Neurodevelopmental Disorders/diagnosis , Language Development Disorders/diagnosis , Bronchopulmonary Dysplasia , Prospective Studies , Cohort Studies , Heart Defects, Congenital/surgery , Genetic Diseases, Inborn
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