Hospital course and duration of oxygen supplementation in children with unoperated intracardiac posttricuspid left-to-right shunts: A prospective observational study.

Abstract

Background: Children with left-to-right (L->R) shunts often need hospital admission and oxygen supplementation due to intercurrent respiratory infection and worsening heart failure. The duration of oxygen requirement in these children is often unknown. This study was done to determine the hospital course of children with unoperated posttricuspid L->R shunts admitted to a hospital with a need for supplemental oxygen. The primary objective was to find the proportion of children requiring prolonged oxygen supplementation (>1 month).

Methods: In this prospective observational study, 122 children with a median (interquartile range) age of 5 (3-8.75) months, having a hemodynamically significant posttricuspid L->R shunt and a need for supplemental oxygen, were enrolled. N terminal B type natriuretic peptide (NT pro-BNP) and C-reactive protein were measured at baseline, 2-, and 3-weeks postenrollment. Decongestive measures, antibiotics, and supportive measures were given, and patients were followed up during their hospitalization.

Results: 22.1% patients died, and 12.3% had prolonged oxygen requirement. 65.5% of admissions and 66.6% of deaths occurred between September and December. At the time of enrollment, NT pro-BNP above age-related cut-off was found in < 20% of patients. On multivariate analysis, the need for mechanical ventilation at admission and the need for escalation of mode of oxygen delivery were independently associated with mortality.

Conclusion: Children with hemodynamically significant posttricuspid L->R shunts admitted to a hospital with a need for supplemental oxygen have an unfavorable short-term outcome. A substantial proportion of children needing oxygen supplementation succumbed. Seasonal variation in admission and mortality was seen. NT pro-BNP was elevated in a minority of patients. These findings may have important clinical implications in the management.