Modified Ross Score for Evaluation of Heart Failure in Children With Lower Respiratory Tract

• Pneumonia in young children remains a global epidemic and a leading cause of death in under-5 children. The annual incidence is approximately 156 million patients worldwide; and pneumonia and its complications led to approximately 0.92 million under-5 deaths in 2015.

In adult patients, cardiac events such as congestive heart failure (CHF) are among the leading complications associated with increased morbidity and mortality, but the association in pediatric patients is not well Established

At Suratthani Hospital, Thailand study therefore investigated the characteristics and factors associated with CHF in under-5 children with pneumonia and respiratory failure (RF). Also, revealed that Pneumonia with respiratory failure is associated with CHF even in healthy children without cardiac risks. The awareness and early recognition of CHF, particularly in male, and bacterial pneumonia is important in order to provide immediate treatment to reduce complications.

• A diagnosis of heart failure due to right ventricular affection requires a high index of suspicion since symptoms of heart failure such as easy fatiguability and tachypnoea are obscured by the primary pulmonary disease itself.6 The American Heart Association recommends early echocardiographic studies to diagnose pulmonary hypertension in children with obstructive apnea and sickle cell anaemia.2 Systolic pulmonary artery pressure can be estimated by echocardiographic Doppler assessment using definition of mean pulmonary artery pressure of >25mmHg. A ten-year review of chronic cor pulmonale secondary to respiratory diseases in Ghana was propelled by the fact that early diagnosis can lead to treatment of the respiratory disease, which would then improve a child's cardiac status. Nine cases of chronic cor pulmonale secondary to respiratory diseases were admitted during the period. Three had bronchiectasis as shown in Table 1. Of the three with bronchiectasis, one had congenital lung aplasia; one had a repair of tracheoesophageal atresia at the age of one week. The other was HIV-positive with bronchiectasis secondary to pulmonary tuberculosis.

Children with right heart failure should be investigated for pulmonary cause since early recognition and treatment would improve outcome