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Background: Cardiac surgery associated acute kidney injury (CS-AKI) is common. Urine response to loop diuretic and urine neutrophil gelatinase associated lipocalin (uNGAL) are separately associated with CS-AKI. We aimed to determine whether urine response to loop diuretic and uNGAL together were associated with postoperative day 2–4 CS-AKI. Methods: Two-center prospective observational study (ages 0–18 years). uNGAL (8–12 h after admission) (ng/mL) and urine response to loop diuretic (6 h for bolus furosemide and 12 h for infusion bumetanide) (mL/kg/hr) were measured. All diuretic doses were converted to furosemide equivalents. The primary outcome was day 2–4 CS-AKI. Patients were sub-phenotyped using a priori cutoffs (uNGAL + ≥ 100 ng/mL and UOP + < 1.5 mL/kg/hr) and optimal cutoffs (uNGAL + ≥ 127 ng/mL and UOP + ≤ 0.79 mL/kg/hr): 1) uNGAL–/UOP–, 2) uNGAL–/UOP + , 3) uNGAL + /UOP–, and 4) uNGAL + /UOP +. Multivariable regression was used to assess the association of uNGAL, UOP and each sub-phenotype with outcomes. Results: 476 patients were included. CS-AKI occurred in 52 (10.9%). uNGAL was associated with 2.59-fold greater odds (95%CI: 1.52–4.41) of CS-AKI. UOP was not associated with CS-AKI. Compared with uNGAL + alone, uNGAL + /UOP + improved prediction of CS-AKI using a priori and optimal cutoffs respectively (AUC 0.70 vs. 0.75). Both uNGAL + /UOP + (IQR OR:4.63, 95%CI: 1.74–12.32) and uNGAL + /UOP– (IQR OR:5.94, 95%CI: 2.09–16.84) were associated with CS-AKI when compared with uNGAL–/UOP–. Conclusions: uNGAL is associated with CS-AKI. The sub-phenotype association was largely driven by uNGAL. Future studies standardizing diuretic dose and timing may be needed to refine the combined performance for clinical decision making. [ABSTRACT FROM AUTHOR]

Background: For an optimal interplay based on the data-secure exchange of diagnostic data between patients, ambulatory care, and hospital care, we implemented the first tele-medical network for pediatric cardiology in Germany, the Congenital Cardiology Cloud. This study focuses on its feasibility, technical characteristics, and implementation in routine clinical work. Methods: Tele-medical traffic comprised numbers of incoming/outgoing data, related file types, treatment options for tele-medically processed patients, and patient classification with respect to the severity of disease. Proof of feasibility was related to the number of successful tele-medical transmissions of discharge documents at the end of the observation period (02/2020–10/2020). Results: Analysis of Congenital Cardiology Cloud's data communication showed a number of 1178 files for a total of 349 patients, favoring transmissions towards the clinic. Incoming traffic was predominantly characterized by diagnostic data regarding tele-consultations (76.6%), consisting of a multitude of file types, whereas 93.4% of the dispatched data corresponded to discharge letters. The number of tele-consultations counted up to 61, with a necessary subsequent treatment or diagnostic procedure in 90.2% of the presented cases. Tele-medically processed patients generally showed to be more complex (severe chronic heart disease 42.4% vs. 23.7%). At the end of the observation period, 97.6% of the discharge documents were transmitted via telemedicine. Discussion: The implementation of the first tele-medical network for pediatric cardiology in Germany proves recent technological developments to successfully enable innovative patient care, connecting the ambulatory and hospital sector for a joint patient advice, predominantly in more complex cases. Possible governmentally guided refinancing concepts will show its long-term feasibility. [ABSTRACT FROM AUTHOR]

Global longitudinal strain (GLS) is a sensitive predictor of cardiotoxicity in adults with cancer. However, the significance of abnormal GLS during childhood cancer treatment is less well-understood. The objective was to evaluate the use of GLS for predicting later cardiac dysfunction in pediatric cancer survivors exposed to high-dose anthracyclines. This was a retrospective study of pediatric patients exposed to a doxorubicin isotoxic equivalent dose of ≥ 225 mg/m2. Transthoracic echocardiograms (TTE) were obtained prior to chemotherapy (T1), during anthracycline therapy (T2), and following completion of therapy (T3). Cardiotoxicity was defined as meeting at least one of the following criteria after anthracycline therapy: a decrease in left ventricle ejection fraction (LVEF) by 10% from baseline to a value < 55%, fractional shortening < 28%, or a decrease in GLS by ≥ 15% from baseline. Nineteen of 57 (33%) patients met criteria for cardiotoxicity at T3. Cardiotoxicity was associated with a lower LVEF at T2 (p = 0.0003) and a decrease in GLS by ≥ 15% at T2 compared to baseline (p = < 0.0001). ROC analysis revealed that the best predictor of cardiotoxicity at T3 was the percent change in GLS at T2 compared to baseline (AUC 0.87). A subgroup analysis revealed that a decrease in GLS by ≥ 15% from baseline at 0–6 months from completion of anthracycline therapy was associated with cardiotoxicity > 1-year post-treatment (p = 0.017). A decline in GLS during chemotherapy was the best predictor of cardiotoxicity post-treatment. GLS serves as an important marker of cardiac function in pediatric patients undergoing treatment with anthracyclines. [ABSTRACT FROM AUTHOR]

Most infants presenting with supraventricular tachycardia (SVT) are treated with an antiarrhythmic, primarily to prevent unrecognized future episodes that could lead to tachycardia-induced cardiomyopathy. A common practice at our institution is to not treat after the first presentation of infant SVT and instead educate parents on heart rate monitoring and reasons to present to care. The goal of this study was to evaluate the outcomes of non-pharmacologic treatment of infant SVT at first presentation and compare to outcomes of infants treated with an antiarrhythmic. This was a retrospective single center study of all infants presenting with a first episode of SVT from 2014 to 2021. Excluded were patients with a non-reentry type tachyarrhythmia, atrial flutter, long-RP tachycardia, congenital heart disease, or abnormal ventricular function. Sixty-four infants were included in the study. Thirty-six were managed without an antiarrhythmic. SVT recurred in 28% of the non-treatment group vs 50% in those treated with antiarrhythmics, p = 0.12. Of the patients admitted to the hospital, those in the non-treatment group had a shorter length of stay, 1(IQR 1–1) vs 3(IQR 2–4) days, p < 0.01. Non-treated patients were less likely to present to the emergency department for recurrent SVT, 6% vs 32%, p < 0.01. Neither group had a patient develop tachycardia-induced cardiomyopathy. For infants with structurally and functionally normal hearts, non-treatment combined with parental education after the first episode of SVT does not lead to worse outcomes. This approach avoids the burden of medication administration in an infant and may have the added benefit of empowering parents to feel comfortable managing clinically insignificant tachycardia at home. [ABSTRACT FROM AUTHOR]

Background: Published guidelines provide recommendations for risk stratification in pediatric Wolff-Parkinson-White (WPW). There are no data on provider concordance with these guidelines. We hypothesized that significant practice variation exists between pediatric cardiologists (PC) and electrophysiologists (EP). Method: The records of all patients, age 8 to 21 years, with a new ECG diagnosis of WPW between 1/1/2013 and 12/31/2018, from a single center, were retrospectively reviewed. Subjects were categorized on the basis of symptoms and resting ECG findings as one of the following: asymptomatic intermittent WPW, asymptomatic persistent WPW, or symptomatic WPW. The performance and results of diagnostic testing, including Holter monitor, event monitor, exercise stress test (EST), and electrophysiology study (EPS), were recorded. The primary outcome was concordance with published guidelines. A secondary outcome was documentation of a discussion of sudden cardiac death (SCD) risk. Results: 615 patient encounters were analyzed in 231 patients with newly diagnosed WPW pattern on ECG (56% male; mean age at diagnosis 13.9 ± 2.5 years). EP were observed to have a significantly higher rate of guideline concordance than PC (95% vs. 71%, p < 0.001). There was significant practice variation between PC and EP in the documentation of a discussion of SCD risk: 96% in EP vs. 39% in PC (p < 0.001). Conclusion: Significant practice variation exists in the non-invasive and invasive risk stratification of pediatric WPW, with lower concordance to published guidelines amongst PC, when compared to EP. This report highlights the need to promote awareness of current WPW guidelines in the pediatric cardiology community at large. [ABSTRACT FROM AUTHOR]

Background: Effective physician-patient communication is crucial to compassionate healthcare, particularly when conveying life-altering diagnoses such as those associated with congenital heart diseases. Despite its importance, medical practitioners often face challenges in communicating effectively. Because of these gaps, we aim to introduce a simulation-based training protocol to improve pediatric cardiology trainee's communication skills. This study will be conducted in collaboration with associations supporting caregivers of children with congenital heart disease. It strives to demonstrate how specific training programs can efficiently foster humanistic, patient-centered care in standard medical practice. Methods: This multicenter, open-label randomized controlled trial will be conducted in pediatric cardiac units and simulation centers of across 10 universities in France. The study population comprises pediatric cardiologists in training (including pediatric cardiac fellows or specialist assistants). The SIMUL-CHD intervention will consist of simulation-based training with standardized patients, focusing on improving communication skills for pediatric cardiology trainees during diagnostic counselling. Patients and caregivers have been recruited from a National Patient Association named "Petit Cœur de Beurre". The primary outcome is the quality of physicians' communication skills. The evaluation committee, which will review video recordings of the sessions, will be blinded to which participants received simulation-based training (group of interest) and which received theory-based training (control group). Secondary outcomes are the effect of SIMUL-CHD on empathy and anxiety levels in young pediatric cardiologists. Baseline scores pre and post-intervention will be compared, and skill improvement resulting from the intervention measured. Discussion: Simulation-based training has proven efficacy in teaching technical skills in various scenarios however its application to communication skills in pediatric cardiology remains unexplored. The involvement of experienced parents provides a unique perspective, incorporating their profound understanding of the emotional challenges and specific hurdles faced by families dealing with congenital heart disease. Trial registration: This trial is registered with the OSF registry (registered https://osf.io/ed78q). [ABSTRACT FROM AUTHOR]

Background: Noonan syndrome (NS) is a congenital genetic disorder with a prevalence of 1 in 1000 to 2500 live births, and is characterized by distinctive facial features, short stature, chest deformities, and congenital heart disease. This study aims to evaluate the prevalence of specific genetic mutations and their impact on cardiovascular and other outcomes in NS. Methods: We conducted a retrospective clinical study of 25 pediatric patients diagnosed with NS at two institutions: The Mother and Child Health Care Institute of Serbia and the Clinic for Children Diseases, University Clinical Center of the Republic of Srpska. Patients underwent whole-exome sequencing (WES) to identify genetic mutations. Clinical data, including cardiovascular manifestations, psychomotor development, and stature, were analyzed in relation to mutation types. Results: The cohort comprised 60% male and 40% female patients, with a median age at diagnosis of 7.2 years. Cardiovascular abnormalities were present in 88% of patients. Mutations in PTPN11 were most commonly associated with pulmonary valve stenosis (PVS), while RAF1 mutations were prevalent in patients with hypertrophic cardiomyopathy (HCM). No significant association was found between cardiac disease and delayed psychomotor development (p = 0.755), even though the likelihood ratio showed significance in that regard (p = 0.018). Short stature was observed in 48% of patients but was not significantly correlated with genetic type of disease, presence of cardiac disease, or developmental delay. Conclusions: The study confirms the high prevalence of cardiovascular manifestations in NS and highlights genotype–phenotype correlations. While cardiac abnormalities are common, their impact on psychomotor development and stature is less clear. Further research is needed to explore genetic interactions influencing these outcomes and refine clinical management strategies. [ABSTRACT FROM AUTHOR]

Introduction: del Nido cardioplegia was developed for immature myocardium to prevent myocardial damage by Ca+2 in traditional blood cardioplegia. But due to increased hemodilution and decreased colloid oncotic pressure it may cause myocardial edema and increased cardiac morbidity. Microplegia may have better cardioprotection in comparison to del Nido as there is less hemodilution. Material and methods: 60 patients from the age group of 1 to 14 years were divided into two groups i.e. del Nido based microplegia group and conventional del Nido group for studying two different cardioplegia technique. Data were collected and compared for intraoperative Hb, CPK-MB and Trop-I levels changes and requirement for defibrillation in intraoperative period. Demographic data, CPB time and ACC time were also collected. Results: Marked elevation in CPK-MB and Trop-I levels were seen in both groups. Statistically significant difference was seen in CPK-MB levels after 6 h of surgery where del Nido group has higher value in comparison to microplegia group. No statistical difference was seen in Trop-I levels in both groups. Strength of correlation (r) was also stronger for CPK-MB rise in association with CPB time and ACC time, in del Nido group but not for Trop-I. Significantly higher hemodilution was also seen in del Nido group after delivering cardioplegia. None of the patients required defibrillation in any group. Conclusion: Lesser hemodilution was seen in microplegia group. Significant cardioprotection is associated with use of microplegia solution in pediatric age group. [ABSTRACT FROM AUTHOR]

Patients with congenital long QT syndrome (LQTS) are prone to ventricular dysrhythmia but may be initially asymptomatic with a normal QTc interval on resting electrocardiogram (ECG). Albuterol is listed as a medication that poses a "special risk" to patients with congenital LQTS, but its effects have been rarely described. We present a case of previously unknown, asymptomatic congenital LQTS unmasked by albuterol in an adolescent with asthma. A 12-year-old girl with a history of asthma presented to the emergency department (ED) with shortness of breath, wheezing, and tachycardia for 24 h, consistent with acute asthma exacerbation. She received two doses of her home albuterol inhaler 2 h prior to presentation. Initial ECG demonstrated a QTc of 619 ms. Her remaining history, clinical examination, and laboratory workup, including electrolytes, were unremarkable. She was observed with cardiac monitoring before being discharged from the ED in stable condition for next-day outpatient pediatric cardiology follow-up. Resting office ECGs revealed QTcs from 440–470 ms. Exercise stress test revealed QTc prolongation of 520 ms and 500 ms at minute-2 and minute-4 of recovery, respectively. Genetic testing revealed heterozygous pathogenic variants in KCNQ1, consistent with type 1 LQTS. Albuterol may be a cause of marked QTc prolongation in ED patients with underlying congenital LQTS, which can be a diagnostic clue in previously unidentified patients. Extreme QTc prolongation also serves as an indication in the ED for Cardiology consultation, laboratory evaluation for electrolyte imbalances, and observation with cardiac monitoring. [ABSTRACT FROM AUTHOR]

Marfan syndrome (MFS) is a hereditary connective tissue disorder with an estimated prevalence of 1:5000–1:10 000 individuals. It is a pleiotropic disease characterized by specific ocular, cardiovascular, and skeletal features. The most common cardiovascular complication is aortic root dilatation which untreated can lead to life-threatening aortic root dissection, mainly occurring in adult patients. Prompt diagnosis, appropriate follow-up, and timely treatment can prevent aortic events. Currently there are no specific recommendations for treatment of children with MFS, and management is greatly based on adult guidelines. Furthermore, due to the scarcity of studies including children, there is a lack of uniform treatment across different centres. This consensus document aims at bridging these gaps of knowledge. This work is a joint collaboration between the paediatric subgroup of the European Network of Vascular Diseases (VASCERN, Heritable Thoracic Aortic Disease Working Group) and the Association for European Paediatric and Congenital Cardiology (AEPC). A group of experts from 12 different centres and 8 different countries participated in this effort. This document reviews four main subjects, namely, (i) imaging of the aorta at diagnosis and follow-up, (ii) recommendations on medical treatment, (iii) recommendations on surgical treatment, and (iv) recommendations on sport participation. [ABSTRACT FROM AUTHOR]

Background: Pediatric cardiology fellows often deliver serious news to families. Effective clinician-patient communication is the basis of strong therapeutic relationships and improves health outcomes, increases patient adherence, and enhances patient satisfaction. Communication training improves physicians' communication skills, ability to deliver serious news, and meet the informational and emotional needs of patients and family members. However, there is little data surrounding pediatric cardiology fellows competencies or training in communication skills. Methods: Pediatric cardiology fellows participated in a 3-hour communication training session. The session used VitalTalk methodology and was facilitated by two VitalTalk facilitators. Fellows spent 1 h learning the skills of delivering serious news and responding to emotion and 2 h in role play with standardized actors followed by a brief group wrap-up activity. Participants took an anonymous, electronic pre- and post-survey and an 8-month follow-up survey via REDCap. Participants were asked about their preparedness and comfort performing certain communication skills and leading challenging conversations specific to pediatric cardiology. Response options used a combination of 0 (low comfort/preparedness) to 100 (high comfort/preparedness) point scales and multiple choice. Results: 9 fellows participated in the training and 100% completed all three surveys. Eight were first-year fellows and 1 was a third-year fellow. Finding the right words, balancing honesty with hope, and clinical and prognostic uncertainty were the top three factors that contributed to making conversations difficult. Following the course, there was a significant increase in fellow preparedness to communicate a new diagnosis of congenital heart disease, discuss poor prognoses, check understanding, and respond to emotion and an increase in fellow comfort responding to emotions. Four fellows reported using the skills from this training course in various clinical settings at 8-month follow up. Conclusions: Communicating serious news effectively is a skill that can be learned in a sustainable way and is essential in the field of pediatric cardiology. Our study demonstrates that an interactive, VitalTalk course can improve preparedness and comfort to deliver serious news in a cohort of pediatric cardiology trainees. Future studies are needed to evaluate translation of skills to clinical practice and durability of these skills in larger cohorts. [ABSTRACT FROM AUTHOR]

Background: Interventional therapies for severe pulmonary arterial hypertension (PAH) can provide right ventricular (RV) decompression and preserve cardiac output. Transcatheter stent placement in a residual ductus arteriosus (PDA) is one potentially effective option in critically ill infants and young children with PAH. We sought to assess recovery of RV function by echocardiographic strain in infants and young children following PDA stenting for acute PAH. Methods: Retrospective review of patients < 2 years old who underwent PDA stenting for acute PAH. Clinical data were abstracted from the electronic medical record. RV strain (both total and free wall components) was assessed from echocardiographic images at baseline and 3, 6, and 12 months post-intervention, as well as at last echocardiogram. Results: Nine patients underwent attempted ductal stenting for PAH. The median age at intervention was 38 days and median weight 3.7 kg. One-third (3of 9) of patients had PAH associated with a congenital diaphragmatic hernia. PDA stents were successfully deployed in eight patients. Mean RV total strain was − 14.9 ± 5.6% at baseline and improved to − 23.8 ± 2.2% at 6 months post-procedure (p < 0.001). Mean free wall RV strain was − 19.5 ± 5.4% at baseline and improved to − 27.7 ± 4.1% at 6 months (p = 0.002). Five patients survived to discharge, and four patients survived 1 year post-discharge. Conclusion: PDA stenting for severe, acute PAH can improve RV function as assessed by strain echocardiography. The quantitative improvement is more prominent in the first 6 months post-procedure and stabilizes thereafter. [ABSTRACT FROM AUTHOR]

Balloon angioplasty for recoarctation of the aorta is routinely performed in young children and is considered successful when the systolic gradient is reduced to < 10 mmHg. IMPACT defines acute procedural success solely based on a final gradient of < 10 mmHg and stratifies participating institutions based on these acute outcomes. Between February 2012 and December 2020, IMPACT data was analyzed for 110 coarctation interventions. Electronic medical records were reviewed, and primary endpoints were one of the following: (1) final analysis end date (June 2021), (2) patient death, or (3) most recent transcatheter or surgical reintervention. 64 (58.2%) interventions had a post-procedure CA gradient < 10 mmHg. Comparison of clinical patient outcome for acute success demonstrated no significant relationship using IMPACT (p = 0.70) criteria. There was no statistically significant difference between clinical success and failure for: pre- and post-treatment systolic gradients; absolute or percent change in systolic gradient; and pre-treatment aorta diameter. Clinical outcome and patient age did show a significant difference (p = 0.0093) with better clinical outcomes in older patients. Our analysis did not reveal a statistically significant difference between IMPACT criteria for successful treatment of CA and clinical outcome. These findings underscore a need to identify other clinical metrics that better predict outcome following CA balloon angioplasty treatment. [ABSTRACT FROM AUTHOR]

Pediatric patients with moderate and great complexity congenital heart disease (CHD) may benefit from coordinated transfer to adult congenital heart disease (ACHD) centers to reduce the risk of complications; however, there are a variety of transfer practices. We examined the impact of referral order placement at the last pediatric cardiology visit on time to transfer to an ACHD center. We analyzed data collected from pediatric patients with moderate and great complexity CHD who were eligible to transfer to our tertiary center's accredited ACHD center. We examined transfer outcomes and time-to-transfer between those with a referral order placed at the last pediatric cardiology visit and those without using Cox proportional hazards modeling. The sample (n = 65) was 44.6% female and mean age at study start was 19.5 years (± 2.2). Referral orders were placed for 32.3% of patients at the last pediatric cardiology visit. Those who had a referral order placed at the last visit had significantly higher number of successful transfers to the ACHD center compared to those who did not (95% vs 25%, p < 0.001). In a Cox regression model, placement of a referral order at the last pediatric cardiology visit was associated significantly with a sooner time to transfer (HR 6.0; 95% CI 2.2–16.2, p > 0.001), adjusting for age, sex, complexity, living location, and pediatric cardiology visit location. Placement of a referral order at the last pediatric cardiology visit may improve transfer occurrence and time to transfer to accredited ACHD centers. [ABSTRACT FROM AUTHOR]

Introduction: We report a case of accelerated idioventricular rhythm (AIVR) identified by Emergency Medical Services (EMS) monitoring of an infant presenting with lethargy and respiratory distress. Accelerated idioventricular rhythms are rare ventricular rhythms originating from the His-Purkinje system or ventricular myocytes, consisting of >3 monomorphic beats with gradual onset and termination.1 An AIVR is usually well-tolerated and does not require treatment, though sustained arrythmia may induce syncope, and the rhythm has been seen in newborn infants with congenital heart diseases.1 Monitoring ill children with ECG can identify such dysrhythmias in the prehospital setting. Case Report: An 18-month-old male presented to their pediatrician with lethargy and respiratory distress, prompting activation of EMS. The patient was placed on a 4-lead ECG initially revealing monomorphic QRS complexes at a rate of 170 beats per minute (BPM). A 12-lead ECG was interpreted as sinus tachycardia by the paramedics who noted the QRS complexes were "getting taller and shorter" with a stable rapid heart rate. The clinician then noted a consistently wide tachycardia which spontaneously converted to a narrow complex tachycardia. The QRS pattern remained variable, with notation of variable R-wave height. After arrival to the emergency department, pediatric cardiology was consulted and interpreted the prehospital ECG findings as accelerated idioventricular rhythm. The patient experienced multiple occurrences of accelerated idioventricular rhythm during hospitalization without associated hypoxia or decreased perfusion. Discussion: Accelerated idioventricular rhythm is relatively rare entity without underlying cardiac disease and most cases are asymptomatic or benign. In the pediatric population, AIVR is generally related to congenital heart defects, cardiac tumors, and cardiomyopathies. In the prehospital setting, continuous ECG monitoring should be a part of care by Advanced Life Support personnel in children with altered mental status, respiratory distress, unexplained syncope, or suspected arrhythmias and 12 lead ECG should be considered if there is any abnormality noted. While this patient did not experience persisting morbidity from AIVR, the potentially hazardous rhythm would not have been recognized without the astute observation, clinical management and persistent follow up of the prehospital clinicians. [ABSTRACT FROM AUTHOR]

Purpose: Hybrid simulation has emerged to increase the practicality of simulation training by combining simulators and standardized patient (SP) that implement realistic clinical environments at a high level. This study aimed to develop a hybrid simulation program focused on case of pediatric cardiac catheterization and to evaluate its effectiveness. Methods: The hybrid simulation program was developed according to the Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model. And deep learning-based analysis program was used to analyze non-verbal communication with SP and applied it for debriefing sessions. To verify the effect of the program, a quasi-experimental study using a random assignment design was conducted. In total, 48 nursing students (n=24 in the experimental group; n=24 in the control group) participated in the study. Results: Knowledge (F=3.53, p=.038), confidence in clinical performance (F=9.73, p<.001), and communication self-efficacy (F=5.20, p=.007) showed a significant difference in both groups and interaction between time points, and the communication ability of the experimental group increased significantly (t=3.32, p=.003). Conclusion: Hybrid simulation program developed in this study has been proven effective, it can be implemented in child nursing education. Future research should focus on developing and incorporating various hybrid simulation programs using SP into the nursing curriculum and evaluating their effectiveness. [ABSTRACT FROM AUTHOR]

Background: Malnutrition and poor weight gain has been reported in infants with congenital heart defects (CHDs); however data in older children with CHDs are limited. In order to obtain representative data on the nutritional status, dietary behavior, and potential influencing factors in school-aged children with CHDs, we performed a nationwide online survey. Methods: Patients aged 6 to 17 years registered in the German National Register for CHDs were asked to participate in this study by completing the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) eating study questionnaire in order to assess their self-reported dietary habits. The use of the same questionnaire enabled a comparison with a representative subset of 4569 participants of the KiGGS study. Results: A total of 894 patients (mean age 12.5 ± 3.0 years; 47.2% female) were enrolled. Patients were allocated according to anatomic complexity into simple (23.8%), moderate (37.8%), and complex CHDs (38.4%). The consumption of sugar-containing food (p < 0.001) and fast food (p < 0.05) was significantly lower among the CHD patients than in the healthy children. Children with CHDs showed significantly lower body mass index (BMI) percentiles (p < 0.001) compared with their healthy peers, while children with complex and moderate CHDs had the lowest BMI. While in CHD patients, the BMI percentiles were not related to unhealthy food, there was a strong correlation with the CHD severity and number of previous interventions (p < 0.01). Conclusions: According to this nationwide survey, school-aged children with complex CHD are at risk of undernutrition, which is not due to dietary habits but to CHD severity and repeated surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Effective physician-patient communication is crucial to compassionate healthcare, particularly when conveying life-altering diagnoses such as those associated with congenital heart diseases. Despite its importance, medical practitioners often face challenges in communicating effectively. Because of these gaps, we aim to introduce a simulation-based training protocol to improve pediatric cardiology trainee’s communication skills. This study will be conducted in collaboration with associations supporting caregivers of children with congenital heart disease. It strives to demonstrate how specific training programs can efficiently foster humanistic, patient-centered care in standard medical practice. Methods This multicenter, open-label randomized controlled trial will be conducted in pediatric cardiac units and simulation centers of across 10 universities in France. The study population comprises pediatric cardiologists in training (including pediatric cardiac fellows or specialist assistants). The SIMUL-CHD intervention will consist of simulation-based training with standardized patients, focusing on improving communication skills for pediatric cardiology trainees during diagnostic counselling. Patients and caregivers have been recruited from a National Patient Association named “Petit Cœur de Beurre”. The primary outcome is the quality of physicians’ communication skills. The evaluation committee, which will review video recordings of the sessions, will be blinded to which participants received simulation-based training (group of interest) and which received theory-based training (control group). Secondary outcomes are the effect of SIMUL-CHD on empathy and anxiety levels in young pediatric cardiologists. Baseline scores pre and post-intervention will be compared, and skill improvement resulting from the intervention measured. Discussion Simulation-based training has proven efficacy in teaching technical skills in various scenarios however its application to communication skills in pediatric cardiology remains unexplored. The involvement of experienced parents provides a unique perspective, incorporating their profound understanding of the emotional challenges and specific hurdles faced by families dealing with congenital heart disease. Trial registration This trial is registered with the OSF registry (registered https://osf.io/ed78q ).

Complex congenital heart disease (CHD) constitutes a significant non-infectious contributor to childhood morbidity and mortality, particularly prevalent in developing countries with an estimated incidence of nearly 1/100 births. The spectrum of CHD spans from isolated atrial septal defects that necessitate no immediate intervention to intricate structural cardiovascular abnormalities demanding multiple interventions early in the neonatal period. Patients afflicted with complex CHD often manifest symptoms such as respiratory distress, cyanosis of the skin, feeding difficulties, and failure to thrive, becoming evident within the initial 48 h post-birth. In this context, we present an intriguing case of a male child with complex CHD. This case study is accompanied by a concise exploration of the embryology of the heart, shedding light on the intricate developmental processes that may underlie such congenital anomalies.

Background: Higher doses of vancomycin are currently prescribed due to the emergence of bacterial tolerance and resistance. This study aimed to evaluate the efficacy and safety of the currently adopted vancomycin dosing guide in pediatric cardiology. Methods: This was a single-center prospective cohort study with pediatric cardiac patients, younger than 14 years, from June 2020 to March 2021. The patients received intravenous vancomycin (40 mg/kg/day divided every 6–8 h) according to the department's vancomycin medication administration guide (MAG) for at least three days. Results: In total, 88 cardiac patients were included, with a median age of 0.82 years (IQR: 0.25–2.9), and 51 (58%) received cardiopulmonary bypass surgery (CPB). The majority (71.6%, n = 61) achieved a serum vancomycin level within the therapeutic range (7–20 mg/L). Infants, young children, and children exposed to CPB surgery had an increased incidence of subtherapeutic vancomycin levels, [7 (29.2%); P = 0.033], [13 (54.2%); P = 0.01], and [21 (87.5%); P = 0.009] respectively. After the treatment, 8 (10%) patients had an elevated Serum creatinine (SCr) and 2 (2.5%) developed acute kidney injury (AKI). However, no significant difference was found between the patients developing AKI or an elevated SCr and the group who did not, in terms of clinical, therapeutic, and demographic characteristics, except for the decreased incidence of SCr elevation in patients receiving an ACE inhibitor, [4 (36.4%); P = 0.036]. Conclusion: Our institution followed MAG recommendations; however, subtherapeutic serum concentrations were evident in infants, young children, and CPB patients. Strategies to prevent AKI should be investigated, as the possible causes have not been identified in this study. [ABSTRACT FROM AUTHOR]

Background: Hypoplastic left heart syndrome (HLHS) was one of the highest mortality congenital heart defects; however, children with HLHS are living longer with medical and technological advancements. This reality resulted in an increased need for primary palliative care. Nurses assume a direct role in providing care to this specific population. Methods: The literature review from PubMed and CINHAL included key terms primary palliative care, pediatric palliative care, pediatric cardiology, HLHS AND nursing care, the role of the pediatric nurse, and pediatric palliative care education. Articles focusing on children with HLHS, pediatric palliative care, the nursing role, pediatric palliative care education, and parental perspectives were included. Articles with a focus on adults with congenital heart disease were excluded. Results: Thirty-three sources were selected for the final review. Palliative care has grown, specializing in children's care. Cardiology providers could improve upon integrating primary palliative care into practice compared to other pediatric specialties. This integration would enhance the quality of life for children with HLHS. Nurses who work with this population are essential in providing this type of care, and require proper education and training. Discussion: After reviewing the articles, it was evident that the nurse's role is crucial in providing primary palliative care to children with HLHS to maintain their quality of life. However, a gap in the literature exists, warranting further research on this topic. Findings in this article suggest that conducting and implementing research and relevant education might provide a better understanding of primary palliative care and its impact on children with HLHS. [ABSTRACT FROM AUTHOR]

Cardiometabolic syndrome (CMS) is a growing concern in children and adolescents, marked by obesity, hypertension, insulin resistance, and dyslipidemia. This study aimed to predict CMS using machine learning based on data from the CASPIAN-V study, which involved 14,226 participants aged 7–18 years, with a CMS prevalence of 82.9%. We applied the XGBoost algorithm to analyze key noninvasive variables, including self-rated health, sunlight exposure, screen time, consanguinity, healthy and unhealthy dietary habits, discretionary salt and sugar consumption, birthweight, and birth order, father and mother education, oral hygiene behavior, and family history of dyslipidemia, obesity, hypertension, and diabetes using five-fold cross-validation. The model achieved high sensitivity (94.7% ± 4.8) and specificity (78.8% ± 13.7), with an area under the ROC curve (AUC) of 0.867 ± 0.087, indicating strong predictive performance and significantly outperformed triponderal mass index (TMI) (adjusted paired t-test; p < 0.05). The most critical selected modifiable factors were sunlight exposure, screen time, consanguinity, healthy and unhealthy diet, dietary fat type, and discretionary salt consumption. This study emphasizes the clinical importance of early identification of at-risk individuals to implement timely interventions. It offers a promising tool for CMS risk screening. These findings support using predictive analytics in clinical settings to address the rising CMS epidemic in children and adolescents. [ABSTRACT FROM AUTHOR]

Purulent pericarditis in children is a life-threatening condition causing cardiac tamponade and disrupting the hemodynamic status of the patient. It has been associated with high mortality if treatment is delayed. Furthermore, purulent pericarditis may lead to constrictive pericarditis in the long term if not fully treated. Acute purulent pericarditis should be seriously considered in every septic child presenting with signs of right heart decompensation. Echocardiography is important for diagnosis. Diagnostic pericardiocentesis should be performed. Recent experience shows that excellent results can be obtained when adequate surgical drainage and antibiotic therapy are combined. We report a case of purulent bacterial pericarditis caused by methicillin-resistant Staphylococcus aureus in an immunocompetent young child presenting with sepsis. The patient was successfully treated with a combined medical and early surgical approach. [ABSTRACT FROM AUTHOR]

Background: The angiotensin-converting enzyme inhibitor (ACEI) enalapril is often administered to infants and young children with heart failure (HF) in various dosing regimens and formulations not adapted for their age. Methods: This prospective, two-center, open-label 8-week study evaluated an age-appropriate formulation of orodispersible minitablets (ODMTs) of enalapril (0.25 mg and 1 mg) in children aged 0 to 6 years with HF due to congenital heart disease. An age/weight-based dosing schedule was followed. Measures of echocardiographic parameters, blood pressure, heart rate, modified Ross score, and biochemistry were obtained over the 8-week period. The following two groups were assessed: ACEI-naïve and ACEI-pretreated patients. Results: In total, 53 children (age range of 0.05 to 4.8 years) were enrolled and 29 were ACEI-naïve. The average enalapril dose was 0.098 mg/kg (0.06–0.17 mg/kg) in the naïve group and 0.15 mg/kg (0.07–0.3 mg/kg) in pretreated patients. After 8 weeks, the modified Ross score and left ventricular diastolic dimension (LVD) z-score showed a significant decrease in both groups (p < 0.005). During 8 weeks follow-up, there were no difference in the z-scores for the systolic blood pressure (p = 0.071) or heart rate (p = 0.146). Conclusions: Pediatric patients treated with ODMTs of enalapril for 8 weeks had favorable improvements in LVD and HF symptoms. [ABSTRACT FROM AUTHOR]

Background: Pediatric cardiac disorders present significant therapeutic challenges. Stem cell therapies have emerged as a potential regenerative solution, offering prospects for substantial cardiac repair and functional improvement in children. Methods: This multicenter, randomized controlled trial evaluated the efficacy and safety of stem cell therapies for cardiac repair in pediatric patients. A total of 200 participants were randomized to receive either stem cell therapy or conventional medical management. The primary outcomes measured were successful cardiac repair, improvement in cardiac function, and the safety profile, including the incidence of adverse events over a follow-up period of one year. Results: The treatment group showed a significantly higher rate of successful cardiac repair (70% vs. 50%, p=0.001) and improvement in cardiac function as evidenced by enhanced ejection fraction and reduced heart size on imaging. The odds ratios for ejection fraction improvement and NYHA class enhancement were 2.85 (95% CI, 1.73 - 4.69, p<0.001) and 2.91 (95% CI, 1.68 - 5.04, p=0.0002), respectively. Adverse events were fewer in the stem cell therapy group compared to the control group (10% vs. 20%, p=0.043). Long-term cardiac function was sustained in a greater proportion of the treatment group (55% vs. 30%, p=0.0003). Conclusion: Stem cell therapy demonstrates significant potential for enhancing cardiac repair and function in pediatric patients with fewer adverse effects compared to conventional treatment. These findings support further research and consideration of stem cell therapies as a viable treatment option in pediatric cardiology. [ABSTRACT FROM AUTHOR]

Lay people are now able to obtain one-lead electrocardiograms (ECG) using smartwatches, which facilitates documentation of arrhythmias. The accuracy of smartwatch derived ECG intervals has not been validated in children though. Home-based monitoring of ECG intervals using a smartwatch could improve monitoring of children, e.g. when taking QTc prolonging medications. The aim of this study was to validate the ECG intervals measured by smartwatch in comparison to standard 12-lead ECGs in children and adolescents. Prospective study of children (age 5—17 years) at the outpatient clinic of a national pediatric heart center. Patients underwent a smartwatch ECG (ScanWatch, Withings) and a simultaneous standard 12-lead ECG. ECG intervals were measured both automatically and manually from the smartwatch ECG and the 12-lead ECG. Intraclass correlation coefficients and Bland–Altman plots were performed. 100 patients (54% male, median age 12.9 (IQR 8.7–15.6) were enrolled. The ICC calculated from the automated smartwatch and automated 12-lead ECG were excellent for heart rate (ICC 0.97, p < 0.001), good for the PR and QT intervals (ICC 0.86 and 0.8, p < 0.001), and moderate for the QRS duration and QTc interval (ICC 0.7 and 0.53, p < 0.001). When using manual measurements for the smartwatch ECG, validity was improved for the PR interval (ICC 0.93, p < 0.001), QRS duration (ICC 0.92, p < 0.001), QT (ICC 0.95, p < 0.001) and QTc interval (ICC 0.84, p < 0.001). Conclusion: Automated smartwatch intervals are most reliable measuring the heart rate. The automated smartwatch QTc intervals are less reliable, but this may be improved by manual measurements. What is Known: In adults, smartwatch derived ECG intervals measured manually have previously been shown to be accurate, though agreement for automated QTc may be fair. What is New: In children, automated smartwatch QTc intervals are less reliable than RR, PR, QRS and uncorrected QT interval. Accuracy of the QTc can be improved by peroforming manual measurements. [ABSTRACT FROM AUTHOR]

This article discusses a case of neonatal flecainide toxicity resulting from a dosing error. It explores the narrow therapeutic index of flecainide and the potential for toxicity in pediatric patients. The article highlights previous cases of dosing errors and their adverse effects. It also discusses the use of activated charcoal and sodium bicarbonate as treatments for flecainide toxicity, as well as other interventions that have shown promise. The document concludes by suggesting measures to prevent dosing errors in the pediatric population. [Extracted from the article]

Aim: The Amplatzer Piccolo Occluder (APO) is approved for patent ductus arteriosus (PDA) occlusion in infants weighing >700 g but could offer versatility to treat other lesions. Methods: Retrospective review of children in whom APO was utilized for defects other than PDA between January 2022 and June 2023. Results: The APO was used in nine patients; three for ventricular septal defects, four with coronary fistulas, one for a ventricular pseudoaneurysm and one where APO deployed within a fenestration of a previously placed Amplatzer Septal Occluder. All nine patients had successful occlusions without complications. Conclusion: The APO is a versatile device that can be used to treat various small diameter lesions in children besides the PDA for which it is currently approved for. Article highlights The Amplatzer Piccolo Occluder (APO) is currently used for closure of patent ductus arteriosus in infants and children. Its utility to treat other small lesions in children has not been previously described. In this series, the APO was used to treat small lesions such as coronary artery fistulas, residual ventricular septal defects, etc. All lesions were successfully treated using the APO, and there were no procedural complications. The APO can be used to successfully occlude small defects of many varieties in infants and children. The advantage of delivering a disc device through a relatively small catheter may prove valuable while treating certain vascular lesions in infants and small children. The 4-French delivery system allows this device to be used in small patients that cannot tolerate the large delivery systems of other devices. The symmetric design of the APO also allows for both antegrade and retrograde deployment. [ABSTRACT FROM AUTHOR]

Previously, it was suggested that biological maturation (BM) could be linked to cardiac autonomic recovery (CAR) in the pediatric population. However, this influence hasn't been confirmed yet. Our aim was to investigate the impact of BM on CAR in female volleyball players. Experimental study with a sample of 38 volleyball players, comprising 20 girls (age: [11.6 ± 2.1] years) and 18 women (age: [24.5 ± 5.5] years), we analyzed BM, comparing maturing subjects (girls) with mature subjects (women). Additionally, we assessed peak height velocity (PHV) in girls. We conducted a training session involving repeated sprints (3 rounds of 6 sprints interspersed by 5 min [min] of passive rest). Using short-range radio telemetry, we analyzed CAR during (at the end of the 1st and 2nd rounds) and after (following the 3rd round) the training session of repeated sprints by applying the 60-s to 300-s heart rate recovery index (HRR-Index). Girls exhibited superior CAR compared to women (round 2: 60-s, 120-s, 240-s, and 300-s, p < 0.005). Subgroup analyses of BM indicated that individuals in the Late-PHV stage demonstrated superior CAR compared to those in the Early-PHV and During-PHV groups. (60-s to 300-s, η²p > 0.4, p < 0.05). Subjects in the During-PHV stage were superior to those in the Early-PHV stage (240-s á 300-s, η² p > 0.4, p < 0.05). We have concluded that biological maturation has a significant impact on cardiac autonomic recovery. [ABSTRACT FROM AUTHOR]

Background and Objectives: Atrial fibrillation (AF) is increasingly recognised in paediatric patients, presenting unique challenges in management due to its association with various underlying heart conditions. This study aimed to evaluate the prevalence, management strategies, and outcomes of AF in this population. Materials and Methods: A retrospective analysis was conducted at a tertiary paediatric cardiology centre, including patients aged ≤18 years diagnosed with AF between January 2015 and December 2023. The study focused on demographic details, clinical presentations, treatments, and outcomes. Descriptive statistics were employed to assess treatment efficacy, recurrence rates, and complications. Results: The study included 36 paediatric patients (median age: 15 years, IQR: 13–17; 58% male). Of these, 52.8% had acquired heart disease, 16.7% had congenital heart anomalies, and 16.7% presented with lone AF. The initial management strategies involved electrical cardioversion in 53.3% of patients and pharmacological conversion with amiodarone in 46.7%. Rhythm control therapy was administered to over 80% of the cohort, and 63.9% were placed on oral anticoagulation, predominantly for rheumatic and congenital heart diseases. The overall success rate of rhythm control was 96.2%, with an AF recurrence rate of 3.8%. Ischemic stroke was the most common complication, occurring in three patients, all with underlying rheumatic heart disease. Conclusions: AF in paediatric patients is predominantly associated with rheumatic and congenital heart diseases, though a significant proportion of patients present with lone AF. Despite effective rhythm control in most cases, neurological complications, particularly ischemic strokes in patients with underlying heart disease, remain a critical concern. These findings underscore the need for more comprehensive studies to better understand the aetiology, risk factors, and optimal management strategies for paediatric AF. [ABSTRACT FROM AUTHOR]

Background: Wearable technologies have been developed to measure physiological parameters conveniently. To consider the new measurement device valid, the crucial point is to assess its reliability with the gold standard. The study aimed to assess the validity of the Pneumonitor (PM, fs = 250 Hz) for acquisition of 5 min RR intervals (RRi) for analysis of heart rate asymmetry (HRA) in relation to the electrocardiography (ECG, fs = 1000 Hz) in a group of 19 pediatric cardiac patients. Association between HRA and respiratory rate (RespRate) was verified. Methods: The validation comprised Bland–Altman analysis, intraclass correlation coefficient, and Student's t-test. Results: Sufficient agreement between 10 from 16 HRA parameters was observed. Different HRA parameters values calculated based on RRi from both devices were related to different results of correlation analysis between two parameters and RespRate. Conclusions: The PM might be considered valid for recording RRi, which are then processed to calculate selected HRA parameters in a group of pediatric cardiac patients in rest condition. However, RRi recorded using devices with fs < 250 Hz may be not adequate for reliable HRA analysis. [ABSTRACT FROM AUTHOR]

Objective: Transcatheter closure of patent ductus arteriosus (PDA) has taken its place as the first choice in the treatment of PDA thanks to the development of new devices and techniques. In this study, we present our cases with PDA closed with Amplatzer duct occluder I (ADO I), Amplatzer duct occluder II (ADO II) and discuss the efficacy and safety of transcatheter PDA closure with these devices in children. Method: Between January 2010 and January 2023, a total of 373 patients underwent PDA closures using ADO I (n=40), and ADO II (n=333) devices in the Pediatric Cardiology Clinic of our hospital and PDA closure was successfully performed in 370 patients. These cases were analysed retrospectively. Results: The mean age of our patients was 3 (0.2-17) years. The mean narrowest diameter of the PDA was 2.48±0.80 mm. Median procedure and fluoroscopy times were 55, and 11 minutes, respectively. The procedure was successful in 99.1% of the cases. PDA was successfully treated in 387 patients using ADO I (n=39), ADO II (n=331) devices. Minimal residual shunt was detected as a minor complication only in 7 patients in the acute phase. In 4 of these 7 patients, residual shunt disappeared completely in the follow-up period, but it persisted in 3 patients. Major complications in our study were device embolisation in 2 patients who underwent ADO I and infective endocarditis that developed in 1 patient 2 weeks after the procedure. In our patient with device embolisation, the device was tried to be removed with the help of a snare, but it failed, so it was surgically removed and the PDA was closed surgically. In our case with infective endocarditis, the device was surgically removed and the PDA was surgically closed. In one patient, the mean pulmonary artery pressure measured during the procedure was found to be high with 29 mmHg, but the procedure was continued because the pulmonary vasoreactivity test was positive. In the procedure performed with ADO I device, the PDA was closed by opening the first disc without releasing the device, but the procedure was not continued because the patient developed desaturation. Conclusion: Transcatheter PDA closure can now be successfully performed in many centres. In this study, we evaluated the cases of PDA closure performed with ADO I and ADO II devices, in the last 13 years. As a result of our study, in accordance with the literature data, we have shown that transcatheter PDA closure using ADO I, ADO II devices is an effective and safe method with low complication rates in children. [ABSTRACT FROM AUTHOR]

Complex congenital heart disease (CHD) constitutes a significant non-infectious contributor to childhood morbidity and mortality, particularly prevalent in developing countries with an estimated incidence of nearly 1/100 births. The spectrum of CHD spans from isolated atrial septal defects that necessitate no immediate intervention to intricate structural cardiovascular abnormalities demanding multiple interventions early in the neonatal period. Patients afflicted with complex CHD often manifest symptoms such as respiratory distress, cyanosis of the skin, feeding difficulties, and failure to thrive, becoming evident within the initial 48 h postbirth. In this context, we present an intriguing case of a male child with complex CHD. This case study is accompanied by a concise exploration of the embryology of the heart, shedding light on the intricate developmental processes that may underlie such congenital anomalies. [ABSTRACT FROM AUTHOR]

Aim: To describe the clinical profile of acute rheumatic fever (ARF) presentations to paediatric cardiology tertiary services in Western Australia (WA). Methods: A retrospective clinical audit of individuals with confirmed ARF referred to the only paediatric tertiary cardiac service in WA (1 January 1987 to 31 December 2020). Comparisons between inpatient, outpatient, remote and non‐remote groups were assessed. Results: Four hundred seventy‐one episodes of ARF in 457 individuals (235 male; median age = 8 years) met clinical criteria. The majority were Aboriginal and Torres Strait Islander children (91.2%), with 62.1% living in remote areas. The number of ARF and rheumatic heart disease (RHD) diagnoses per year increased from 1987 to 2017 with notable peaks in 2013 and 2017. The average annual incidence of tertiary‐referred ARF in WA of 4–15‐year‐olds from 1987 to 2020 was 4.96 per 100 000. ARF features included carditis (59.9%), chorea (31%), polyarthritis (30%) and polyarthralgia (24.2%). RHD was evident in 61.8% of cases and predominantly manifested as mitral regurgitation (55.7%). Thirty‐four children (7.4%) with severe RHD underwent valvular surgery. 12% had at least one recurrent ARF episode. Remote individuals had more than double the rate of recurrence compared to non‐remote individuals (P = 0.0058). Compared to non‐remote episodes, remote presentations had less polyarthritis (P = 0.0022) but greater proportions of raised ESR (P = 0.01), ASOT titres (P = 0.0073), erythema marginatum (P = 0.0218) and severe RHD (P = 0.0133). Conclusion: The high proportion of Aboriginal and Torres Strait Islander Australians affected by ARF/RHD in WA reflects the significant burden of disease within this population. Children from remote communities were more likely to present with concurrent severe RHD. Our study reinforces the persisting need to improve primary and secondary ARF initiatives in rural and remote communities. [ABSTRACT FROM AUTHOR]

Background: Limited research exists on the influence of social determinants of health (SDOH) on outcomes in pediatric patients with advanced heart failure receiving mechanical circulatory support. Methods: Linkage of the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) and Society of Thoracic Surgeon's Congenital Heart Surgery Database (STS‐CHSD) identified pediatric patients who underwent ventricular assist device (VAD) implantation from 2012 to 2022 with available residential zip codes. Utilizing the available zip codes, each patient was assigned a Childhood Opportunity Index (COI) score. Level of childhood opportunity, race, and insurance type were used as proxies for SDOH. Major outcomes included death, transplant, alive with device, and recovery. Secondary outcomes were adverse events. Statistical analyses were performed using the Kaplan–Meier survival, competing risk analyses, and multivariable Cox proportional hazards model. Results: Three hundred seventeen patients were included in the study. Childhood opportunity level and insurance status did not significantly impact morbidity or mortality after VAD implantation. White race was associated with reduced 1‐year survival (71% in White vs. 87% in non‐White patients, p = 0.05) and increased risk of pump thrombosis (p = 0.02). Conclusion: Childhood opportunity level and insurance status were not linked to morbidity and mortality in pediatric patients after VAD implantation. Notably, White race was associated with higher mortality rates. The study underscores the importance of considering SDOH in evaluating advanced therapies for pediatric heart failure and emphasizes the need for accurate socioeconomic data collection in future studies and national registries. [ABSTRACT FROM AUTHOR]

Our essay discusses the impact of underrepresentation in medical training, with a focus on pediatric cardiology. We use the perspective of a physician who is underrepresented in medicine (URiM), and has chosen to pursue a career in pediatric cardiology, to initiate an analysis of the current path toward pediatric cardiology and the factors in undergraduate and graduate medical education which could currently be optimized to improve diversity in training. We argue that a lack of diversity among physicians leads to worse patient outcomes, and we describe steps to improve representation in the field. In order to improve representation in pediatric cardiology, we must reflect upon our current practices and implement systemic changes within cardiology training program recruitment and retention practices. These changes should include continuous mentorship of URiM trainees interested in cardiology and prioritization of research that investigates social determinants of health which may disproportionally affect minority patients. [ABSTRACT FROM AUTHOR]

Cardiopulmonary exercise testing (CPET) provides clinicians with information vital to the management of pediatric cardiology patients. CPET can also be used to measure cardiorespiratory fitness (CRF) in these patients. CRF is a robust marker of overall health in children. However, a complete understanding of CRF in pediatric cardiology patients is limited by lack of large, standardized CPET databases. Our purpose was to develop a standardized CPET database, describe available data at our institution, and discuss challenges and opportunities associated with this project. CPETs performed from 1993 to present in an urban pediatric hospital were collected and compiled into a research database. Historical data included demographic and clinical variables and CPET outcomes, and additional variables were calculated and coded to facilitate analyses in these cohorts. Patient diagnoses were coded to facilitate sub-analyses of specific cohorts. Quality assurance protocols were established to ensure future database contributions and promote inter-institutional collaborations. This database includes 10,319 CPETs (56.1% male), predominantly using the Bruce Protocol. Patients ranging from ages 6 to 18 years comprise 86.8% of available CPETs. Diagnosis classification scheme includes patients with structurally normal hearts (n = 3,454), congenital heart disease (n = 3,614), electrophysiological abnormalities (n = 2,082), heart transplant or cardiomyopathy (n = 833), and other diagnoses (n = 336). Historically, clinicians were provided with suboptimal interpretive resources for CPET, often generalizing inferences from these resources to non-representative clinical populations. This database supports representative CRF comparisons and establishes a framework for future CRF-based registries in pediatric patients referred for CPET, ultimately improving clinical decision-making regarding fitness in these populations. [ABSTRACT FROM AUTHOR]

BACKGROUND: The interstage period after discharge from stage 1 palliation carries high morbidity and mortality. The impact of social determinants of health on interstage outcomes is not well characterized. We assessed the relationship between childhood opportunity and acute interstage outcomes. METHODS: Infants discharged home after stage 1 palliation in the National Pediatric Quality Improvement Collaborative Phase II registry (2016-2022) were retrospectively reviewed. Zip code-level Childhood Opportunity Index (COI), a composite metric of 29 indicators across education, health and environment, and socioeconomic domains, was used to classify patients into 5 COI levels. Acute interstage outcomes included death or transplant listing, unplanned readmission, intensive care unit admission, unplanned catheterization, and reoperation. The association between COI level and acute interstage outcomes was assessed using logistic regression with sequential adjustment for potential confounders. RESULTS: The analysis cohort included 1837 patients from 69 centers. Birth weight (P<0.001) and proximity to a surgical center at birth (P=0.02) increased with COI level. Stage 1 length of stay decreased (P=0.001), and exclusive oral feeding rate at discharge increased (P<0.001), with higher COI level. More than 98% of patients in all COI levels were enrolled in home monitoring. Death or transplant listing occurred in 101 (5%) patients with unplanned readmission in 987 (53%), intensive care unit admission in 448 (24%), catheterization in 345 (19%), and reoperation in 83 (5%). There was no difference in the incidence or time to occurrence of any acute interstage outcome among COI levels in unadjusted or adjusted analysis. There was no interaction between race and ethnicity and childhood opportunity in acute interstage outcomes. CONCLUSIONS: Zip code COI level is associated with differences in preoperative risk factors and stage 1 palliation hospitalization characteristics. Acute interstage outcomes, although common across the spectrum of childhood opportunity, are not associated with COI level in an era of highly prevalent home monitoring programs. The role of home monitoring in mitigating disparities during the interstage period merits further investigation. [ABSTRACT FROM AUTHOR]

Introduction: The congenital heart disease (CHD) makes the largest group of congenital defects children are born with. The conservative estimate points towards 1% prevalence of CHD among the newborn. In India, each year approximately 2.4 lakh children are born with CHD, which is largest in the world. There are very centres offering paediatric cardiology services in India and they are unevenly distributed. Because of this, a lot of paediatric patients with CHD get treated at an adult cardiology facility, not always equipped with proper setup to handle complexities associated with paediatric cardiology work. The study aims to assess the safety and complications associated with paediatric cardiology catheterization-based procedures in a Cath lab is primarily used for adult cardiology work. Methods: The current study is a retrospective review of pediatric cardiac cath-lab-based procedures performed between April 2018 and March 2021. Results: During the study, 110 pediatric patients underwent 110 cath-lab-based procedures. A total of 20 procedures were performed as an emergency, and 90 were performed as planned procedures. Out of 110 procedures performed, 86.4% were completed without complications. Minor complications were observed in 9.1% of the procedure. Major complications were seen in 3 patients, and two patients died. Conclusion: The analysis shows that the complications associated with pediatric cardiac procedures performed on rural-based cath-lab oriented toward adult cardiology work are comparable to those of other large-volume pediatric cardiac centres. [ABSTRACT FROM AUTHOR]

Introduction: Perinatal asphyxia is defined as the failure to initiate and sustain breathing at birth. Aim: compare functional echocardiographic parameters of perinatal asphyxiated term neonates with non asphyxiated term neonates. Methodology: This observational study, conducted at the Division of Pediatric Cardiology in M.D.M Hospital under the Department of Pediatrics, Dr. S.N. Medical College, Jodhpur, focused on perinatal asphyxia and hypoxic ischemic encephalopathy (HIE). Perinatal asphyxia severity was classified as moderate or severe based on breathing patterns and APGAR scores at 1 minute after birth. HIE diagnosis relied on physical examination, utilizing the modified Sarnat & Sarnat staging system to determine severity. Result: our observational study compared functional echocardiographic parameters between perinatal asphyxiated term neonates and non-asphyxiated term neonates. The findings revealed significant differences in certain parameters between the two groups: La and Ao did not differ significantly between the study and control groups.The ratio of La to Ao was significantly higher in the study group. LVES was significantly larger in the study group. EF and FS were significantly lower in the study group, indicating impaired cardiac function. Other parameters such as LVMPI, MAPSE and mitral E/A and E/e' ratios did not show significant differences between the two groups. However, the diastolic diameter of the tricuspid annulus was significantly larger in the study group compared to the control group. Conclusion: The perinatal asphyxia may impact specific echocardiographic parameters indicative of cardiac dysfunction, particularly in terms of left ventricular systolic function.Early recognition and management of cardiac involvement may improve outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR]

The cardiac biomarkers high sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are utilised in paediatric healthcare for the diagnosis and prognostic assessment of many conditions including myocarditis, congenital heart disease, multisystem inflammatory syndrome in children (MIS-C) and heart failure. However, the standardised age-related reference intervals, 99th percentile cut-offs and clinical guidelines are not available, making the interpretation of these biomarkers challenging. This study aimed to generate normative data in a paediatric cohort for the Siemens Atellica® IM 1300 analyser. Residual plasma samples were collected from children aged up to 17 years attending primary care and out-patient settings and with no apparent evidence of cardiac dysfunction, renal dysfunction or other confounders. Reference intervals were generated using the 2.5th–97.5th percentiles, and 99th percentile cut-offs determined according to CLSI EP28-A3c. Statistical analysis revealed that partitioning was not required for gender for either biomarker. The reference interval for hs-cTnI for children aged one month to 16 years (n=292, 146 females and 146 males) was <14 ng/L with a 99th percentile cut-off of 19 ng/L. The reference interval for NT-proBNP for children aged one month up to one year was <714 ng/L (n=14) and for children aged 1–16 years (n=339) was <295 ng/L. This is the first paediatric reference interval data generated on the Siemens Atellica® solution. These reference intervals and 99th percentiles will inform clinical decisions in the paediatric cardiology setting. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular (CV) risk factors can be transmitted from mothers to their children. However, it is challenging to measure and identify subclinical CV risk in young children using traditional CV risk methods and metrics. Objective: The purpose of this study was to determine the feasibility of recruiting mother-child dyads and measuring arterial stiffness (pulse wave velocity, augmentation index/pressure), blood pressure (BP), BP circadian pattern, specifically nocturnal BP dipping, and CV health metrics in mothers and in children aged 1 to 5 years. Methods: All BP and arterial stiffness measures were obtained using the noninvasive automated oscillometric Mobil-O-Graph device. Also measured were blood cholesterol level; glucose level; body mass index (BMI); and smoking, diet, and physical activity history. Descriptive statistics were used for assessing recruitment feasibility and Pearson correlations for mother-child associations. Results: Thirty-five mother-child dyads completed the protocol. Recruitment reach was 89% and retention rate was 80%. Mothers were 34.3 ± 5.4 years old with a mean systolic BP (SBP) of 114.6 ± 9.5 mm Hg and BMI of 26.0 ± 6.5. Children were 3 ± 1.4 years old with a mean SBP of 103.3 ± 9.4 mm Hg and BMI z -scores of −0.3 ± 1.5. Arterial stiffness parameters were within normal ranges for mothers and children. Twenty-three percent of mothers did not exhibit nocturnal dipping (<10% decrease between day and nighttime SBP). Maternal SBP was positively correlated with child BMI z -scores (r = 0.42, P =.022) as well as mother-child augmentation pressure (r = 0.51, P =.010). Conclusions: Our findings support using a mother-child approach and novel noninvasive approaches to assess and target CV risk in mothers and their young children. [ABSTRACT FROM AUTHOR]

The evolution of paediatric care in the UK is a compelling journey that reflects medical progress and a profound commitment to improving the health and wellbeing of children. Paediatric medicine has undergone significant transformations, from a nascent field with limited understanding to a dynamic and multidisciplinary domain focused on specialized care and groundbreaking research. This review aims to summarize the major advancements in the various paediatric specialties in the UK. As paediatric care evolved, the emergence of paediatric subspecialties became increasingly prevalent. Paediatric cardiology, haematology, and various other disciplines gained prominence, allowing for more targeted and effective treatments. The integration of research into paediatric medical practice became a driving force, leading to innovative discoveries and therapies. Contemporary paediatric care in the UK is characterized by a holistic approach that extends beyond treating illnesses to promoting overall wellbeing. The ongoing journey reflects a dynamic field that continues to adapt and innovate, promising a brighter and healthier future where every child receives the most effective and compassionate healthcare possible. [ABSTRACT FROM AUTHOR]

Anthracyclines have significantly improved the survival of children with malignant tumors, but the associated cardiotoxicity, an effect now under the purview of pediatric cardio-oncology, due to its cumulative and irreversible effects on the heart, limits their clinical application. A systematic screening and risk stratification approach provides the opportunity for early identification and intervention to mitigate, reverse, or prevent myocardial injury, remodeling, and dysfunction associated with anthracyclines. This review summarizes the risk factors, surveillance indexes, and preventive strategies of anthracycline-related cardiotoxicity to improve the safety and efficacy of anthracyclines. [ABSTRACT FROM AUTHOR]

Background: Approximately 50% of children experience a cardiac murmur at some point in their lives; <1% of these murmurs are attributed to congenital heart disease (CHD). Cardiac murmur might be the first clinical sign of a significant CHD in children. Despite careful routine medical examinations at birth, approximately 50% of CHD cases could remain unrecognised. Objective: Cardiovascular symptoms and signs could be specific or non-specific in neonates and children with heart murmurs. Knowledge about red flags in history and physical examinations, and syndromic associations of common CHDs are important. Auscultatory skills to identify systolic, diastolic and continuous murmurs and heart sounds are essential. Differential diagnosis should be formulated based on the location of maximum intensity of murmurs. Younger infants and children with pathological murmurs and red-flag signs should be promptly referred to local paediatric cardiology services for further investigations. Discussion: Significant skill and knowledge are required for the identification of critical murmurs and associated cardiovascular problems. This review provides a simplified comprehensive update on cardiac murmurs and associated conditions in neonates and children. [ABSTRACT FROM AUTHOR]