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7 results

  • Oxygen requirement as a screening tool for the detection of late pulmonary hypertension in extremely low birth weight infants

  • Rohit Aswani, Lisa Hayman, Gina Nichols, Angel A. Luciano, Ernest K. Amankwah, Jennifer L. Leshko, Gul H. Dadlani
  • Journal:
    Cardiology in the Young / Volume 26 / Issue 3 / March 2016
    Published online by Cambridge University Press:
    29 June 2015, pp. 521-527
  • Background

    Many extremely low birth weight infants develop pulmonary hypertension late in their clinical course, and over 60% go undetected by early screening echocardiography. At present, no standardised screening protocol exists for detecting late pulmonary hypertension in extremely low birth weight infants. We assessed the utility of oxygen supplementation as a predictor of late pulmonary hypertension.

    Methods

    A retrospective single-centre review of extremely low birth weight infants with no evidence of CHD and those surviving for >30 days was performed. The association between oxygen ⩾30% at day of life 30 and diagnosis of late pulmonary hypertension was estimated with an odds ratio and 95% confidence interval using logistic regression. Doppler echocardiography was used to diagnose pulmonary hypertension in the infants.

    Results

    A total of 230 infants met the study criteria. The incidence of late pulmonary hypertension was 8.3% (19/230). Infants with late pulmonary hypertension were more likely to have a lower mean birth weight (667.1±144 versus 799.3±140 g, p=0.001) and more likely to be small for gestational age (47.4 versus 14.2%, p=0.004). Oxygen requirement ⩾30% at day of life 30 was associated with increased risk of late pulmonary hypertension (odds ratio=3.77, 95% confidence interval=1.42–10.00, p=0.008) in univariate analysis and after adjusting for birth weight (odds ratio=2.47, 95% confidence interval=0.89–6.84, p=0.08).

    Conclusions

    The need of oxygen supplementation ⩾30% at day of life 30 may be a good screening tool for detecting late pulmonary hypertension in extremely low birth weight infants.

  • 23 - Cardiac problems

    • By Gul H. Dadlani, Congenital Heart Institute of Florida, All Children's Hospital and University of South Florida, St. Petersburg, FL, USA, Steven E. Lipshultz, Sylvester Comprehensive Cancer Center University of Miami and Miller School of Medicine, Holtz Children's Hospital, University of Miami-Jackson Memorial Medical Center, FL, USA
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book:
    Handbook of Pediatric HIV Care
    Published online:
    23 December 2009
    Print publication:
    04 May 2006, pp 554-566

  • Summary

    Introduction

    As the survival of HIV-infected patients improves, the cardiovascular complications of HIV infection are becoming an increasingly common cause of morbidity and mortality. The prevalence of cardiovascular disease is estimated to be more than 90% in pediatric HIV patients [1–3]. The spectrum of cardiovascular disorders includes abnormalities in left ventricular performance, wall thickness, contractility, dilated cardiomyopathy, myocarditis, pericarditis, and rhythm disturbances. Cardiac complications have surpassed pulmonary disease as the leading cause of death in HIV-infected patients [4]. The recognition of cardiovascular complications can be very difficult because many patients are asymptomatic until late in the disease course. In addition, the cardiac symptoms can be inadvertently attributed to other causes such as pulmonary or infectious etiologies. Early detection of these symptoms is only possible if clinicians have a fundamental understanding of the wide array of cardiovascular complications associated with HIV infection. The initiation of routine screening and monitoring will allow clinicians the ability to intervene and hopefully prevent or delay the onset of these complications in the future.

    Risk factors

    Several risk factors for cardiovascular disease among HIV-infected children have been described. The triad of encephalopathy, wasting, and low CD4 counts in children with HIV have been shown to be associated with an increased the risk of cardiovascular complications and decreased survival [5]. Encephalopathy can lead to an autonomic neuropathy, which may precipitate arrhythmias or even sudden death [5].

  • 30 - Cardiac problems

  • from Part IV - Clinical manifestations of HIV infection in children
    • By Gul H. Dadlani, Divison of Pediatric Cardiology, Golisano Children's Hospital at Strong and University of Rochester Medical Center, Rochester, NY, Steven E. Lipshultz, Divison of Pediatric Cardiology, Golisano Children's Hospital at Strong and University of Rochester Medical Center, Rochester, NY
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
  • Book:
    Textbook of Pediatric HIV Care
    Published online:
    03 February 2010
    Print publication:
    28 April 2005, pp 468-478

  • Summary

    Introduction

    The cardiovascular complications of HIV infection are increasingly contributing to the overall morbidity and mortality of this pediatric population. The prevalence of cardiovascular disease is estimated to be more than 90% in both symptomatic and asymptomatic HIV-infected children [1]. The spectrum of cardiovascular disorders includes abnormalities in left ventricular (LV) performance, wall thickness, and contractility; dilated cardiomyopathy; myocarditis; pericarditis; and rhythm disturbances. These children may have a wide spectrum of presenting symptoms for their cardiovascular complications, but most are initially asymptomatic. The cardiovascular symptoms may be inadvertently attributed to other causes, such as pulmonary or infectious processes, which may delay treatment. Early detection of and intervention for subclinical cardiovascular abnormalities through routine screening and monitoring will allow the clinician to initiate therapy with the goal of preventing or delaying the onset of clinical cardiovascular complications. Today the survival of pediatric HIV patients has improved and cardiac complications are increasing as the underlying cause of death (Figure 30.1) [2, 3]. Therefore, clinicians need a fundamental understanding of the cardiovascular complications that can arise from HIV infection in pediatric patients.

    Risk factors

    Several risk factors for cardiovascular disease among HIV-infected children have been described. The triad of encephalopathy, wasting, and low CD4+ counts in children with HIV has been shown to be associated with an increased risk of cardiovascular complications and a decreased survival [3]. Encephalopathy can lead to an autonomic neuropathy, which may precipitate arrhythmias or even sudden death [4].