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      Control de los niños con cardiopatía congénita en Atención Primaria Translated title: Control of children with congenital heart diseases in Primary Care

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          Abstract

          Las cardiopatías congénitas son frecuentes, pero la mayoría son leves y no requieren cuidados pediátricos especiales. En España y otros países desarrollados, las que los necesitan son corregidas pronto, se limita su período sintomático y generalmente presentan pocas secuelas. Por todo ello, el seguimiento de los niños con cardiopatía congénita en Atención Primaria ocasiona poca carga asistencial. Sin embargo, para algunos pacientes, como los que tienen defectos más complejos, los cuidados pediátricos son importantes. En este trabajo se revisan los conocimientos actuales al respecto.

          Translated abstract

          Congenital heart diseases are frequent, but most of them are minor and do not require special pediatric care. In Spain and other developed countries those who need it are corrected soon, limiting the symptom's period and usually have with few sequelae. For these reasons, the follow up of children with congenital heart diseases suppose little work load for the primary care units. Nevertheless, pediatric care is important for some patients, like those who have more complex defects. The current knowledge about this subject is reviewed in this paper.

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          Most cited references28

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          Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure.

          This study aimed to evaluate the relationship between anemia and heart failure (HF) prognosis. Although it is known that chronic diseases, including HF, may be associated with anemia, the impact of hemoglobin (Hb) level on symptoms and survival in HF has not been fully defined. We analyzed a cohort of 1,061 patients with advanced HF (New York Heart Association [NYHA] functional class III or IV and left ventricular ejection fraction [LVEF] 14.8 g/dl. Mean Hb was 13.6, and values ranged from 7.1 to 19.0 g/dl. The Hb groups were similar in age, medication profile, LVEF, hypertension, diabetes, smoking status and serum sodium. Lower Hb was associated with an impaired hemodynamic profile, higher blood urea nitrogen and creatinine, and lower albumin, total cholesterol and body mass index. Patients in the lower Hb quartiles were more likely to be NYHA functional class IV (p < 0.0001) and have lower peak oxygen consumption (PKVO(2)) (p < 0.0001). Survival at one year was higher with increased Hb quartile (55.6%, 63.9%, 71.4% and 74.4% for quartiles 1, 2, 3 and 4, respectively). On multivariate analysis adjusting for known HF prognostic factors, low Hb proved to be an independent predictor of mortality (relative risk 1.131, confidence interval 1.045 to 1.224 for each decrease of 1 g/dl). In chronic HF, relatively mild degrees of anemia are associated with worsened symptoms, functional status and survival.
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            Prophylaxis against infective endocarditis: Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures

            (2008)
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              Parameters of iron deficiency in children with cyanotic congenital heart disease.

              A group of 67 children with cyanotic congenital heart disease (CCHD) were studied, and 35 were given iron treatment according to a regimen that gives iron to patients with a hematocrit (Hct) below 60%. The patients were categorized as iron-deficient and iron-sufficient according to their transferrin saturation and ferritin values. The pretreatment hemoglobin (Hb) and Hct values of the groups were similar. The mean Hct was nearly three times as much as the mean Hb in the iron-sufficient group and more than three times as much as the Hb in the iron-deficient group. Excessive erythrocytosis in the iron-deficient group was impressive. Mean corpuscular volume (MCV) values were below 72.7 fl in all of the iron-deficient patients. After treatment the Hb, Hct, transferrin saturation, and ferritin increased significantly in both groups, with the increments greater in the iron-deficient group. Increments in the erythrocyte (RBC) count were significant in the iron-sufficient group but insignificant in the iron-deficient one. Increments of MCV in the iron-deficient group were significant but insignificant in the iron-sufficient group. Our study demonstrated that prediction of Hb, RBC count, and MCV, measurements of which are easy and inexpensive and require little blood, can suffice for the diagnosis of iron deficiency in patients with CCHD without altering systemic perfusion.

                Author and article information

                Contributors
                Role: ND
                Journal
                pap
                Pediatría Atención Primaria
                Rev Pediatr Aten Primaria
                Asociación Española de Pediatría de Atención Primaria (Madrid )
                1139-7632
                December 2009
                : 11
                : 44
                : 639-655
                Affiliations
                [1 ] Centro de Salud El Abajón de Las Rozas Spain
                Article
                S1139-76322009000500011
                10.4321/s1139-76322009000500011
                7187827b-a00f-46b7-9c04-9f40be106f3b

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                PEDIATRICS

                Pediatrics
                Congenital heart disease,Primary Care,Cardiopatías congénitas,Atención Primaria
                Pediatrics
                Congenital heart disease, Primary Care, Cardiopatías congénitas, Atención Primaria

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