Cardiac failure in children with pneumonia in Papua New Guinea

Background. Cardiac failure is suspected of contributing to mortality from pneumonia in children in developing countries, but its role has not been cl early defined. Methods. A convenience sample of 47 children admitted to Goroka Hospital in Papua New Guinea was studied prospectively with ultrasound, chest radiogra phs and assays of creatine kinase and lactate dehydrogenase. Results. Seven (15%) of the 47 children died. Of the 43 children who had a chest radiograph, 31 (72%) had severe or very severe pneumonia. No child ha d poor contractility of the heart on ultrasound examination or unequivocall y raised cardiac isoenzymes; therefore no evidence of myocardial injury fro m sepsis was found. However, ultrasound examination showed dilatation of th e right ventricle or hepatic veins in 12 (26%) of the children (both were d ilated in 7 children) and 4 (33%) of these children died; this suggests tha t right ventricular cardiac failure secondary to pulmonary hypertension was present in 26% (95% confidence interval, 14 to 40%) of these children with severe pneumonia. Tachycardia was not associated with right ventricular di latation on ultrasound, but 3 of the 4 children with more than 3 cm of live r palpable in the abdomen had right ventricular dilatation. Only 4 of the 1 2 children with right heart failure had hepatomegaly, tachycardia, raised j ugular venous pressure or peripheral edema. Conclusions. Right ventricular failure is common in children with severe pn eumonia, and it is probably caused by pulmonary hypertension rather than se ptic toxemia, The clinical signs of heart failure are unreliable. There is no evidence that digoxin is effective treatment for right ventricular failu re secondary to pulmonary hypertension.