Heart Failure Clinical Trial
Official title:
Modified Ross Score for Evaluation of Heart Failure in Children With Lower Respiratory Tract
- Identification of Patient those at risk For heart failure associated with lower
respiratory tract infection
- Assess the value of Ross score evaluation in lower respiratory tract infection
complicated with HF, as a diagnostic tool for severity of HF
- Pneumonia in young children remains a global epidemic and a leading cause of death in
under-5 children. The annual incidence is approximately 156 million patients worldwide; and
pneumonia and its complications led to approximately 0.92 million under-5 deaths in 2015.
In adult patients, cardiac events such as congestive heart failure (CHF) are among the
leading complications associated with increased morbidity and mortality, but the association
in pediatric patients is not well Established
At Suratthani Hospital, Thailand study therefore investigated the characteristics and factors
associated with CHF in under-5 children with pneumonia and respiratory failure (RF). Also,
revealed that Pneumonia with respiratory failure is associated with CHF even in healthy
children without cardiac risks. The awareness and early recognition of CHF, particularly in
male, and bacterial pneumonia is important in order to provide immediate treatment to reduce
complications.
- A diagnosis of heart failure due to right ventricular affection requires a high index of
suspicion since symptoms of heart failure such as easy fatiguability and tachypnoea are
obscured by the primary pulmonary disease itself.6 The American Heart Association recommends
early echocardiographic studies to diagnose pulmonary hypertension in children with
obstructive apnea and sickle cell anaemia.2 Systolic pulmonary artery pressure can be
estimated by echocardiographic Doppler assessment using definition of mean pulmonary artery
pressure of >25mmHg. A ten-year review of chronic cor pulmonale secondary to respiratory
diseases in Ghana was propelled by the fact that early diagnosis can lead to treatment of the
respiratory disease, which would then improve a child's cardiac status. Nine cases of chronic
cor pulmonale secondary to respiratory diseases were admitted during the period. Three had
bronchiectasis as shown in Table 1. Of the three with bronchiectasis, one had congenital lung
aplasia; one had a repair of tracheoesophageal atresia at the age of one week. The other was
HIV-positive with bronchiectasis secondary to pulmonary tuberculosis.
Children with right heart failure should be investigated for pulmonary cause since early
recognition and treatment would improve outcome
Until 1987, the only system available for grading HF in children was the New York Heart
Association (NYHA) classification. However, this system was based on limitations to physical
activity for adults, which did not translate well for use with children, particularly
infants.2 Therefore, we developed a symptom-based classification using more age-appropriate
variables. new Ross HF classification from grades I to IV
Several authors have modified Ross scoring system to expand its use to older children.
with all this recent data on factors predictive of outcomes in children with HF that a
revision in how we grade symptom severity is required. It also is apparent that age
stratification is required to encompass the changes in signs and symptoms that children
manifest from infancy to late childhood. A classification system should include the
biomarkers, echo parameters of systolic function and mitral or systemic atrioventricular
valve (AV) insufficiency, and reflect exercise limitations reflected by feeding and growth in
infants and exercise capacity indicated by percentage of predicted maximal oxygen uptake
(VO2) in older children. Therefore an age-based Ross classification using the original
variables that proved to be sensitive and specific and adding the new evidence-based data.
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