Anaemia in solitary acyanotic ventricular septal defect in comorbid with pneumonia or pulmonary hypertension: A retrospective study of 75 paediatric cases

Abstract

Background: Ventricular septal defects (VSD) are the second commonest congenital heart defects after bicuspid aortic valve. When left unrepaired, they can undergo spontaneous closure or elicit a spectrum of complications including pneumonia (PNA) or pulmonary hypertension (PH) with subsequent anaemia. In this retrospective study, we aim to establish and compare the prevalence of anaemia in patients with solitary acyanotic VSD in comorbid with PNA or PH. Methods: A total of 75 case files of patients with solitary acyanotic VSD, who underwent surgical closure or device occlusion had haemoglobin level analysed prior to the procedure. The cohort included patients with (history of) PNA and PH, and asymptomatic. The cohort included 27 females and 48 males with mean age and weight of 8.3±5.72 (3-24) months and 5.9±3.9 (2.7-17.8) kilograms, respectively. Depending on  associated complication and age, the cohort was divided: PNA (A), PH (B) and Control (C); and (I) young children (≥3-6≤) and (II) older children (>6-≤24) months. We used 95 and 105 grams per litre as haemoglobin lower threshold level for (I) and (II), respectively. Results: According to data analysis 27 patients (36%) in total had anaemia. Of the anaemia cohort 16 (59.3%) had PNA, 9 (33.3%) PH and 2 (7.4%) were asymptomatic. Of the cohort, 42 were young children, with anaemia prevalence of 19/42 (45.2%), while 24.2% of the older children had anaemia. Intergroup ANOVA independent sample t-test was significant (p<0.05). In addition, intergroup Tukey HSD test for haemoglobin: A/B (p>0.05), A/C (p<0.01), B/C (p<0.01).  Conclusion: Paediatric patients with acyanotic VSD in comorbid with PNA or PH are 8 and 4 times more susceptible to develop anaemia compared to asymptomatic counterparts. Susceptibility is even higher among young children (3-6months). However, a prospective study is needed to validate our findings.