Prognostic indices in childhood heart failure.

OBJECTIVES: To evaluate the short term prognosis of childhood heart failure and highlight the factors that affect outcome among cases of heart failure admitted into the paediatric wards, University College Hospital, Ibadan.

BACKGROUND: Childhood heart failure remains a major cause of morbidity and mortality in the developing world. The advent of open heart surgery, use of better myocardial preservative techniques, and the introduction of newer, more effective drugs in the treatment of heart failure have greatly improved the outcome of children with heart failure in the developed world. The outlook of such children in the developing world however remains poor.

METHODS: One hundred consecutive cases of heart failure admitted into the Paediatric wards of the University College Hospital, Ibadan with a diagnosis of heart failure over a 10-month period were studied prospectively. Diagnosis of heart failure was based on the presence of at least three of the four cardinal signs of heart failure: tachypnoea, tachycardia, tender hepatomegaly and cardiomegaly. All cases were followed up daily till a definite outcome was determined.

RESULTS: The predominant underlying causes of heart failure were acute respiratory infections (36%), severe anaemia (28%), and congenital heart disease (25%). There was a case-fatality rate of 24% among the study population. Poor prognostic indices identified were age below one year or above 5 years, presence of underlying acute respiratory infections, rheumatic heart disease and renal disorders.

CONCLUSION: Heart failure in Nigerian children though mostly due to preventable causes, are associated with an unacceptably high mortality.