Outcome of Infants with Unrepaired Heart Disease Admitted to the Pediatric Intensive Care Unit: Single-center Developing Country Perspective

Objective: Congenital heart disease (CHD) has an incidence of ~0.8-1%. Outcome of previously diagnosed CHD patients awaiting surgery (either correction or palliation) in a developing country setting is unknown. We strive to determine the outcome of patients with CHDawaiting surgery who present to pediatric intensive care unit (PICU) setting with an acute illness. Design: Retrospective cross-sectional chart review. Setting: Pediatric intensive care unit of The Aga Khan University Hospital, Karachi, Pakistan. Patient: Medical records of infants (1-12 months) with CHDawaiting surgery presenting to the PICU with an acute illness between January 2009 and June 2012 were included. Newly diagnosed CHD patients, those not requiring PICU admission, and those transferred to another hospital were excluded. Results: A total of 34 infants met the inclusion criteria. Median age at presentation was 5 months. Seventy-four percent of the infants had CHD lesion characterized by increased pulmonary blood flow (shunt lesions). Though none of the patients met the strict criteria for sepsis or pneumonia, 74% were admitted with a diagnosis of pneumonia or sepsis. Only 15% of patient had congestive heart failure as an admitting diagnosis. Oxygen therapy was given to 94% of these patients. Fifty-nine percent of these patients expired during the admission, 95% of those expired had multiorgan dysfunction. Conclusion: Patients with CHDawaiting surgery and who admitted to the PICU with acute illness are at high risk for mortality. Stringent criteria to diagnose pneumonia or sepsis should be used in these patients.