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Myocardial dysfunction in children with dengue haemorrhagic fever
S K Kabra1, R Juneja, Madhulika
1Department of Paediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Insights
Myocardial dysfunction may contribute to hypotension in children with dengue hemorrhagic fever, even with adequate fluid replacement. Further assessment is needed, especially in persistent hypotension cases.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Dengue hemorrhagic fever (DHF) is a significant tropical health issue, often leading to hypotension presumed to be caused by capillary leak and fluid depletion.
- World Health Organization guidelines emphasize fluid replacement therapy for DHF, but challenges in fluid management were observed during a 1996 New Delhi epidemic.
- This study investigated myocardial dysfunction as a potential additional factor contributing to hypotension in pediatric DHF cases.
Purpose of the Study:
- To investigate the potential role of myocardial dysfunction in pediatric dengue hemorrhagic fever (DHF).
- To assess cardiac function in children with DHF using echocardiography.
- To explore the correlation between myocardial dysfunction and clinical severity in DHF.
Main Methods:
- Echocardiography (M-mode, 2D, color Doppler) was performed on 54 children (<12 years) with varying grades of DHF.
- Ejection fractions and shortening fractions were calculated using Teichholz and Modified Simpson's rules.
- Clinical assessment and echocardiographic parameters were analyzed in relation to disease severity.
Main Results:
- Reduced ejection fraction (<50%) was observed in 16.7% (9/54) of children, with 2 cases showing significant reduction (<35%).
- Myocardial dysfunction was present across all clinical severity grades of DHF.
- Improved ejection fractions were noted in 3 children who underwent repeat echocardiography within two months.
Conclusions:
- The precise role of myocardial dysfunction in DHF-related hypotension requires further definition, as no clear correlation with clinical severity was found.
- Cardiac function assessment is recommended for DHF patients, particularly those with persistent hypotension despite appropriate hydration.
- Myocardial dysfunction may be an underrecognized contributor to hypotension in pediatric dengue hemorrhagic fever.
Background:
Dengue fever/dengue haemorrhagic fever/dengue shock syndrome is a serious health problem in tropical countries. Intravascular fluid depletion due to capillary leak is presumed to be the cause of hypotension in dengue haemorrhagic fever. The treatment guidelines of the World Health Organization lay stress primarily on monitoring and fluid replacement therapy. During the 1996 epidemic in New Delhi, we observed problems in fluid management of such children and prospectively looked for myocardial dysfunction as an additional factor for hypotension.
Methods:
Fifty-four children (< 12 years old) admitted to the All India Institute of Medical Sciences, New Delhi after 15 October 1996 with various grades of the disease, who were fit to be shifted to the echocardiography laboratory, were examined clinically and subjected to a detailed M-mode, 2-dimensional and colour doppler echocardiography. Ejection fractions (Teichholz/Modified Simpson's) and shortening fractions were calculated.
Results:
Ejection fraction by modified Simpson's rule was reduced (< 50%) in 9/54 (16.7%) children; 2 of these had significant reductions (< 35%). These 9 children belonged to all stages of clinical severity. Three of these 9 children who had a repeat echocardiogram within 2 months of the illness had improved ejection fractions.
Conclusion:
The role of myocardial dysfunction remains to be defined as there was no correlation with clinical severity. Myocardial functions need to be assessed in patients with this disease, especially those who have persistent hypotension in spite of adequate hydration.