Clinical Retrospective Study Of Congenital Heart Disease Complicated With Severe Pneumonia In Children

Objective To compare the related history,complications,laboratory examination,treatment and outcome of children with congenital heart disease(CHD)complicated with severe pneumonia(SP)and children with SP alone,and to summarize the disease characteristics of children with CHD complicated with SP,to analysis the distribution and drug resistance of pathogenic bacteria in sputum culture of CHD complicated with SP,to discuss the early warning role of red blood cell distribution width in evaluating secondary pulmonary hypertension in children with CHD complicated with SP,so as to assist clinical decision-making,promote the standard of diagnosis and treatment,improve treatment level,and improve prognosis of children.Methods Clinical data of 138 children with CHD complicated with SP and 165 children with simple SP admitted to the General Hospital of Ningxia Medical University from September 2020 to September 2022 were collected,including general information,basic medical history,complications,laboratory examination,treatment measures and discharge outcome,etc.Statistical software SPSS 26.0 was used for statistical description and inference,and clinical characteristics were compared and analyzed.Children with CHD combined with SP were divided into two groups: pulmonary hypertension group and no pulmonary hypertension group.Binary Logistic regression was used to analyze the linear relationship between RDW and pulmonary hypertension,and ROC curve was drawn.Results1.General information: CHD combined with SP was most common in infancy(85.5%),in boys(58.0%)and in winter and spring(60.1%).CHD was mainly in left-to-right type(93.5%).The incidence of recurrent pneumonia(39.9%),malnutrition(44.9%),anemia(37.7%)and congenital malformations outside the circulatory system(34.8%)were higher than those in the control group(P<0.05).2.Complications:The main complications of acute respiratory failure(97.8%),acute heart failure(32.6%),pulmonary hypertension(29.7%),cardiac enlargement(6.5%),acid-base imbalance(61.6%),pericardial effusion(15.9%),abdominal and pelvic effusion(4.3%)were more common than those of the control group(P<0.05).3.Laboratory indicators: In 138 children with CHD complicated with SCAP,p H<7.35(25.4%),Pa O2<80mm Hg(57.2%),Pa CO2>46mm Hg(14.5%),Pa O2/Fi O2<200(26.8%)were more common than those in the control group(P<0.05).In blood routine,the incidence of RDW increased(47.8%)was higher than that in control group(P<0.05).Among the coagulation indexes,PT and APTT were longer than that in control group,INR was increased,FIB was insufficient,and PT increased(12.3%),APTT increased(18.1%),INR>1.5(9.4%),FIB<2g/L(53.6%)were more common than those in control group(P<0.05).In blood biochemistry,the incidence of urea increased(17.4%),creatinine increased(8.7%),total bilirubin increased(13.8%)and total protein decreased(60.1%)were more common than those in control group(P<0.05).The Ig A level was lower than that of control group(P<0.05).4.RDW>14.55% predicted secondary pulmonary hypertension in children with CHD and SP with 78.0% sensitivity and 62% specificity,and the area under ROC curve was 0.71(95%CI: 0.617-0.792,P<0.001).5.Etiological examination: sputum culture was positive in 57 cases(41.3%),including38 cases(27.5%)of gram-negative bacteria infection,17 cases(12.3%)of gram-positive bacteria infection and 5 cases(3.6%)of fungal infection.There was no significant difference between the total positive rate of bacterial infection(P>0.05).The top 3 gram-negative bacterias were Haemophilus influenzae,Acinetobacter baumannii and Klebsiella pneumoniae,while the main gram-positive bacterias were Staphylococcus aureus and Streptococcus pneumoniae.The main fungi were Candida albicans.There were 26 cases(18.8%)with positive Ig M antibody of the pathogen of respiratory tract infection,including 15 cases(10.9%)with Mycoplasma pneumoniae infection,the infection rate was lower than that of the control group(P<0.05),13 cases(9.4%)with human respiratory syncytial virus infection,the infection rate was higher than that of the control group(P<0.05).6.Drug susceptibility test results: the main gram-negative bacillus Haemophilus influenzae was sensitive to cephalosporins,penicillins and carbapenems,Acinetobacter baumannii was sensitive to cefuroxime,cefoperazone/sulbactam and meropenem,and Klebsiella pneumoniae was sensitive to gentamicin,cefoperazone/sulbactam and meropenem.The main gram-positive coccus Staphylococcus aureus and Streptococcus pneumoniae were sensitive to levofloxacin,Vancomycin,gentamicin and linezolid.7.Treatment and prognosis: 138 patients with CHD complicated with SP received empirical antibiotic therapy immediately after admission(100.0%),90 patients received combined antibiotic therapy(65.2%),and 3 patients received antifungal drugs(2.2%).Mechanical ventilation rate was 97.8%,endotracheal intubation rate was 48.6%,both higher than those in control group(P<0.05).The utilization rates of positive inotropic drugs,diuretics and vasoactive drugs were 55.1%,55.8% and 21.0%,which were higher than those of control group(P<0.05).There were 10 cases(7.25%)underwent emergency operation,9cases were improved after successful operation,and 1 case died in hospital after operation.103 cases were effectively treated(74.6%),35 cases were treated ineffectively(25.4%),and the effective rate of treatment was lower than that of control group(P<0.05).Conclusion1.Children with CHD complicated with SP are more common in infants,and are more prone to recurrent pneumonia than children with simple SP,with higher incidence of malnutrition,anemia,congenital malformations outside the circulatory system,PAH,AHF and ARF.2.RDW can be used as a clinical marker to evaluate secondary pulmonary hypertension in children with CHD complicated with SP.3.Children with CHD complicated with SP are more likely to have abnormal coagulation function,abnormal liver and kidney function,and partially low humoral immune function than children with SP alone,so attention should be paid to monitoring.4.The dominant pathogen in children with CHD complicated with SP is bacteria,mainly gram-negative bacteria.For such children,anti-gram-negative bacteria can be used as the main agent,supplemented by anti-gram-positive bacteria as appropriate.5.Children with CHD complicated with SP should undergo radical surgery as soon as possible if the medical treatment is not effective or ineffective.