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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.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|April 24, 2007
PubMed

Insights

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.
Abstract

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