PATTERN OF CHILDHOOD CONGESTIVE HEART FAILURE AT LAGOS UNIVERSITY TEACHING HOSPITAL, LAGOS

Abstract

Congestive heart failure (CHF) is a common paediatric emergency with diverse aetiologies, associated with high morbidity and mortality. There is currently no existing data on the epidemiological and clinical characteristics of CHF in children seen at the Lagos University Teaching Hospital (LUTH). The present study was undertaken to determine the epidemiology and the severity of heart failure. In a cross- sectional prospective study conducted at LUTH between June 2009 and May 2010, a total of 220 children aged day1 to 15years diagnosed with CHF based on standard criteria, were consecutively recruited into the study from both the paediatric wards and the children’s emergency room. The severity of CHF was determined by using a heart failure severity index score for children. A total of 3,846 children were admitted during the study period and 220 of these were diagnosed with CHF, giving a prevalence of 5.72%. Two children with CHF were excluded from further analysis because they were discharged before relevant data could be obtained. Of the remaining 218 patients studied, 113 were males and 105 were females (M: F ratio 1.1: 1). Thirty two (14.7%) of these patients were neonates, 100(45.9%) were infants, 60(27.5%) were pre-school age and 26(11.9%) were school aged children. The mean age of the study population was 22.6±32.7 months. Causes of CHF in this study were severe anaemia (39.4%), lower respiratory tract infections (26.1%), congenital heart disease (16.1%), acquired heart disease (6.4%), septicaemia (5.5%), renal failure (2.8%), severe perinatal asphyxia (2.3%) and others (1.4%). Malaria was the commonest cause of anaemia. The analysis of degree of severity showed that 23.8%, 30.3% and 45.9% presented with mild, moderate and severe heart failure respectively and the difference in distribution was statistically significant (p<0.01). The factors which
affected the severity of heart failure were low packed cell volume on admission (p=0.04), low socio-economic class (p=0.03) and the cause of the heart failure (p=0.02). Of the 218 cases of heart failure studied, 33 died giving a mortality of 15.1%. The short term factors that affected mortality in children with CHF were renal disease (p=0.03) and acquired heart disease (p=0.004) as the cause of the heart failure, presence of severe heart failure on admission (p<0.001), lower socio economic status (p=0.003) and readmission for heart failure (p=0.007). Evidence of heart failure should be sought for in all acutely ill children including newborns and routine use of heart failure severity index in the various health institutions in the country will aid early diagnosis and identification of high risk children who need intensive and prompt therapeutic measures thereby aid in reducing the prevalence, morbidity and mortality associated with childhood heart failure in our environment

PATTERN OF CHILDHOOD CONGESTIVE HEART FAILURE AT LAGOS UNIVERSITY TEACHING HOSPITAL, LAGOS