Pulmonary hypertension in children aged two to twenty four months hospitalised with severe pneumonia at two tertiary hospitals in Harare, Zimbabwe

Abstract

Objectives: The aim of the study was to describe the echocardiographic findings in children hospitalized with severe pneumonia, in particular the presence of pulmonary hypertension.

Design:  A descriptive cross-sectional study was undertaken.

Setting:  Paediatric medical wards in two tertiary, teaching hospitals in Harare, Zimbabwe.

Subjects:  Consecutive sampling of 206 children aged 2 to 24 months meeting the WHO case definition of severe pneumonia whose caregivers gave informed consent.

Main Outcome Measures: Echocardiography findings of left ventricular contractility and estimated pulmonary hypertension defined as elevated Right Ventricular Systolic Pressure (RVSP) >25mmHg, both assessed by 2D echocardiography.

Results:   Elevated RVSP was found in 11.3% (n=22/195) of the participants with a mean of 35(4.2). This was not significantly associated with mortality (p=0.291). The following factors were significantly associated with elevated RVSP (p=<0.05): central cyanosis, SPO2 < 90% and at least two previous hospitalizations with pneumonia. Most, 98% (n=191) of patients had normal left ventricular contractility based on ejection fraction and fractional shortening. Ten of the participants died (10/195), giving a case fatality rate of 5.1%.

Conclusion: Pulmonary hypertension was found to be a complication in 11.3% of children hospitalized with severe pneumonia. Further studies are needed to evaluate its persistence.