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Home inotropic therapy in children
Alexandria M Berg1, Lecia Snell, William T Mahle
1Sibley Heart Transplant Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Summary
Continuous home inotropic therapy is a safe option for pediatric patients with advanced congestive heart failure (CHF). This approach offers potential cost savings and improved family well-being by reducing prolonged hospitalizations.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Inotropic therapy is standard for advanced pediatric congestive heart failure (CHF).
- New UNOS criteria permit home discharge for heart transplant candidates (1B status).
- Home inotropic therapy is established in adults but understudied in children.
Purpose of the Study:
- To evaluate the safety and efficacy of continuous ambulatory home inotropic therapy in pediatric patients.
- To assess the feasibility of home-based inotropic support as a bridge to transplantation or for palliative care.
Main Methods:
- Retrospective review of 14 pediatric patients with end-stage CHF receiving home intravenous inotropic therapy.
- Data collected from a single institution between January 2000 and January 2007.
- Analysis of therapy indications, agents used (milrinone, dobutamine), duration, and adverse events.
Main Results:
- 14 pediatric patients (age 6-18) received home inotropic therapy for palliative care (8) or as a bridge to transplant (6).
- Most patients received milrinone; therapy duration ranged from 14 to 476 days.
- Adverse events included 26 hospital re-admissions and 4 suspected catheter infections, with no unexpected deaths or pump failures.
Conclusions:
- Continuous home inotropic therapy appears safe for children with CHF, exhibiting few complications.
- This treatment modality may reduce healthcare costs and enhance family dynamics by shortening hospital stays.
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