Diagnosis and Treatment
Diagnosis of congestive failure in infants and children is based
on symptomatology, chest radiographic films, ECG findings,
echocardiographic techniques to assess cardiac structures and
ventricular function (i.e., end-systolic and end-diastolic diameters),
arterial blood gases to determine intracardiac shunting
and ventilation-perfusion inequalities, and other laboratory
studies to determine anemia and electrolyte imbalances.
Treatment of congestive failure in infants and children includes
measures aimed at improving cardiac function and
eliminating excess intravascular fluid. Oxygen delivery must
be supported and oxygen demands controlled or minimized.
When possible, the cause of the disorder is corrected (e.g., medical
treatment of sepsis and anemia, surgical correction of congenital
heart defects). With congenital anomalies that are
amenable to surgery, medical treatment often is needed for a
time before surgery and usually is continued during the immediate
postoperative period. For many children, only medical
management can be provided.
Medical management of heart failure in infants and children
is similar to that in the adult, although it is tailored to the
special developmental needs of the child. Inotropic agents such
as digitalis often are used to increase cardiac contractility. Diuretics
may be given to reduce preload and vasodilating drugs
used to manipulate the afterload. Drug doses must be carefully
tailored to control for the child’s weight and conditions such as
reduced renal function. Daily weighing and accurate measurement
of intake and output are imperative during acute episodes
of failure.
Most children feel better in the semiupright position. An infant
seat is useful for infants with chronic CHF. Activity restrictions
usually are designed to allow children to be as active as
possible within the limitations of their heart disease. Infants
with congestive failure often have problems feeding. Small, frequent
feedings usually are more successful than larger, less fre-quent feedings. Severely ill infants may lack sufficient strength
to suck and may need to be tube fed.