Short-Term Impact of Cardiac Intervention on the Nutritional Status of Malnourished Children with Congenital Heart Disease - A Report from a Developing African Country, Ethiopia.

Background and Objective: Malnutrition is a common problem in infants and children with congenital heart defect and has an impact on the disease outcome. This study aimed to assess the short-term impact of corrective cardiac intervention on growth recovery of malnourished children with congenital heart defects. Methods: A retrospective cohort study was conducted over a year period (April 2021 to April 2022) by retrieving data from pediatric corrective cardiac interventions performed over a period of 5 years (2017-2021). We enrolled pediatric patients with congenital heart disease whose age is less than 18 years and have undergone corrective cardiac intervention. Those children identified to have malnutrition pre-operatively have been followed for 6 months postoperatively. Anthropometry measurements were used to measure the outcome, before intervention and every 3 months for a total of 6 months after correction. Results: A total of 148 children from age 2 months to 18 years with a mean age of 5 years were included in the study. Most of the subjects had acyanotic CHD accounting for 93.2%. Magnitudes of underweight, wasting and stunting at pre intervention were 54%, 54.1% and 59.5% respectively, decreased to 40.7%, 39.2%, 49.2% and 29.3%, 25.9%, 34.8% at the 3rd and 6th month of the post intervention period respectively. Predictors of undernutrition at post intervention were type of CHD, age at correction, PAH, type of intervention and were summarized. Comparison of Z-scores for WFH and HFA on the 3rd and 6th month post intervention has shown significant improvement from baseline. Those subjects with PAH and older age at correction have a greater chance of being underweight and wasted. Conclusion: Malnutrition is very common in children with CHD and is predicted by the presence of pulmonary hypertension and older age at correction. Corrective cardiac intervention significantly improved nutritional status during the follow-up over 6 months.

Isolated Asymptomatic Fetal Intracardiac Mass: A Case of Rhabdomyoma.

Introduction: Fetal cardiac rhabdomyoma is one of the rare benign cardiac masses which is commonly associated with the tuberous sclerosis complex (TSC). Though mostly fetal cardiac rhabdomyoma is asymptomatic it may lead to life-threatening conditions like outflow obstruction, arrhythmias, hydrops fetalis, or sudden fetal death. Case Report: We are reporting an isolated, asymptomatic fetal intra-cardiac mass (rhabdomyoma) that was discovered at 32 weeks of gestation and was followed as an outpatient until 39 weeks plus one day, at which point a cesarean section was performed. After delivery, the child underwent evaluations at the 1st day, 7th day, 30th day, 7th month, and 12th month of age. Following a checkup, the child's anthropometric and neurobehavioral growth were both healthy. Except for the tumor, which was neither growing nor shrinking in size, none of the clinical diagnostic criteria for tuberous sclerosis complex were met for this child up to the age of one year. Conclusion: The most common primary benign fetal cardiac tumor is cardiac rhabdomyoma, which is usually associated with tuberous sclerosis. In developing nations where it is challenging to obtain MRIs and genetic studies, and in a similar patient like ours with no other features of tuberous sclerosis, the child needs to be followed in the future, bearing in mind that tuberous sclerosis manifestations will continue to develop over a patient's lifetime.

Nutritional assessment and associated factors in children with congenital heart disease-Ethiopia.

INTRODUCTION: Worldwide, congenital heart disease is the principal heart disease in children and constitutes one of the major causes of infant mortality, particularly in developing countries. Infants and children with congenital heart disease exhibit a range of delays in weight gain and growth. In some instances, the delay can be relatively mild, whereas in other cases, cause the failure to thrive. OBJECTIVES: To determine the nutritional status and associated factors of pediatric patients with congenital heart disease. MATERIAL AND METHOD: A cross sectional analytical study conducted over a period of 6 months (Feb to Jul 2020). A total of 228 subjects with congenital heart disease who visited the cardiac center during the study period where included until the calculated sample size attained. Data is collected from patient's card and their care giver. Data was then analyzed using Statistical Package for Social Sciences (SPSS) for windows version 25.0. Odds Ratio with 95% Confidence Interval (CI) was used to determine the effect of the independent variables on the outcome variable and P-value less than 0.05 was considered statistically significant. RESULTS: A total of 228 children ranging from 3month to 17yrs of age with mean age of 4.7 years (SD = 3.8 years) were included in the study. Most of the subjects had acyanotic heart disease accounting for 87.7%. The overall prevalence of wasting, underweight and stunting were 41.3%, 49.1% and 43% respectively. Children with congenital heart disease and having pulmonary hypertension, were found more likely to develop wasting compared to those without pulmonary hypertension with an odds of 1.9 (95% CI: 1.0-3.4) and also have greater chance of stunting with an odds of 1.9 (95% CI: 1.0-3.4). Children 5 to 10 years of age were 2.3 times more likely to be underweight. CONCLUSION: Malnutrition is a major problem in pediatric patients with congenital heart disease. Pulmonary hypertension and older age are associated with increased risk of undernutrition.

High risk of early sub-therapeutic penicillin concentrations after intramuscular benzathine penicillin G injections in Ethiopian children and adults with rheumatic heart disease.

INTRODUCTION: Intramuscular benzathine penicillin G (BPG) injections are a cornerstone of secondary prophylaxis to prevent acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Uncertainties regarding inter-ethnic and preparation variability, and target exposure profiles of BPG injection are key knowledge gaps for RHD control. METHODS: To evaluate BPG pharmacokinetics (PK) in patients receiving 4-weekly doses in Ethiopia, we conducted a prospective cohort study of ARF/RHD patients attending cardiology outpatient clinics. Serum samples were collected weekly for one month after injection and assayed with a liquid chromatography-mass spectroscopy assay. Concentration-time datasets for BPG were analyzed by nonlinear mixed effects modelling using NONMEM. RESULTS: A total of 190 penicillin concentration samples from 74 patients were included in the final PK model. The median age, weight, BMI was 21 years, 47 kg and 18 kg/m2, respectively. When compared with estimates derived from Indigenous Australian patients, the estimate for median (95% confidence interval) volume of distribution (V/F) was lower (54.8 [43.9-66.3] l.70kg-1) whilst the absorption half-life (t1/2-abs2) was longer (12.0 [8.75-17.7] days). The median (IQR) percentage of time where the concentrations remained above 20 ng/mL and 10 ng/mL within the 28-day treatment cycle was 42.5% (27.5-60) and 73% (58.5-99), respectively. CONCLUSIONS: The majority of Ethiopian patients receiving BPG as secondary prophylaxis to prevent RHD do not attain target concentrations for more than two weeks during each 4-weekly injection cycle, highlighting the limitations of current BPG strategies. Between-population variation, together with PK differences between different preparations may be important considerations for ARF/RHD control programs.