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Update on pediatric heart failure

Del Castillo, Sylviaa; Shaddy, Robert E.b; Kantor, Paul F.b

doi: 10.1097/MOP.0000000000000807
CARDIOVASCULAR MEDICINE: Edited by Daniel Bernstein
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Purpose of review This review highlights recent advances in the diagnosis and management of children with heart failure. We emphasize the clinical approach to patient care in the areas of acute decompensated heart failure, chronic heart failure, and failure of the patient with single ventricle physiology.

Recent findings Important guidelines regarding the recognition and management of heart failure in children have been proposed and adopted, providing guidance for early recognition and ongoing management. Early diuresis, and avoidance of excessive inotropic agent use, in favor of milrinone as an inotropic-vasodilator agent, are emphasized. Close monitoring of airway pressures to improve ventricular filling, and extubation to positive pressure or high-flow nasal cannula therapy are also important. Chronic heart failure therapy requires combination treatment with diuretics, and the three major classes of drugs. Management of the failing Fontan requires attention to the hepatic, pulmonary and lymphatic circulations.

Summary Improved outcomes in children with heart failure are possible. Inherent in this success is the engagement of an interdisciplinary team-based approach to care, with early recognition and escalation of care for specific patients who are not improving as predicted.

aDepartment of Anesthesiology Critical Care Medicine

bDepartment of Pediatrics, University of Southern California Keck School of Medicine, Children's Hospital Los Angeles, California, USA

Correspondence to Paul F. Kantor, MBBCh, 4650 Sunset Boulevard, MS #34, Los Angeles, CA 90027, USA. Tel: +1 323 361 2716; e-mail: pakantor@chla.usc.edu

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