Epidemiological, Diagnostic and Therapeutic Aspects of Cardiogenic Shock in Children at the Albert Royer Children’s Hospital in Dakar

Introduction: The objective of this study was to evaluate the epidemiological, diagnostic and therapeutic aspects of cardiogenic shock in children at the Albert Royer Children’s Hospital in Dakar. Methods: This was a retrospective, descriptive and analytical study from January 2020 to February 2021, including all children aged 2 months to 16 years hospitalised for cardiogenic shock diagnosed on the basis of clinical and ultrasound criteria. Results: During the study, 38 patients were hospitalised for cardiogenic shock. The hospital prevalence was 4.2%. The mean age of onset of shock was 64 months, and there was a predominance of females with a sex ratio of 1.92. Consanguinity was found in 42% of the patients. Consanguinity was found in 42% of patients. Infection was identified as a trigger for cardiogenic shock in 18 (52.9%) of our patients. The most common type of heart disease was rheumatic heart disease in 12 (32%) of the patients. The mortality rate was 65.8%. Conclusion: Cardiogenic shock is a diagnostic and therapeutic emergency. Its prevalence and mortality are still high in developing countries.


Introduction
Cardiogenic shock is an acute circulatory failure due to impaired myocardial How to cite this paper: Mbodj, M., Fall, A.L., Thiongane, A., Diagne, I., Sow, A., Ndiaye, S.T., Bop, K., Sow, P.S. and Ndiaye, O. (2021) Epidemiological, Diagnostic and Therapeutic Aspects of Cardiogenic Shock in Children at the Albert Royer Children's Hospital in Dakar. Open Journal of Pediatrics, 11, 669-675. Open Journal of Pediatrics contractility resulting in decreased cardiac output and pulmonary congestion [1]. It is an immediate life-threatening emergency. More frequent in adults, in whom it represents the main cause of mortality of patients hospitalised for myocardial infarction, cardiogenic shock is much rarer in children [2]. In children and infants, it can occur de novo in a healthy heart or in pre-existing congenital or chronic heart disease [3]. Heart failure in paediatric populations is a major public health problem. It is associated with high rates of hospitalisation, disability and mortality in high-income countries, but its burden is poorly documented in developing countries [4]. There are few published studies on cardiogenic shock in children worldwide and none in Senegal. It is in this context that we conducted this study to evaluate the epidemiological, diagnostic and therapeutic aspects of cardiogenic shock in children.

Methodology
This work was carried out at the Centre Hospitalier National d'Enfants Albert Royer (CHNEAR), which is the only exclusively paediatric level 3 public health establishment (EPS) in the Dakar region. It houses a paediatric cardiology department where the majority of children with congenital or acquired heart disease are followed. The study was retrospective, descriptive and analytical over a period of 14 months (from 01 January 2020 to 28 February 2021). Epidemiological, diagnostic, therapeutic and evolutionary parameters were collected from medical records and hospital registers. We included all children aged 2 months to 16 years hospitalised for cardiogenic shock confirmed on the basis of clinical criteria such as: tachycardia, prolonged skin recolouration time, arterial hypotension associated with signs of heart failure (hepatomegaly, gallop rhythm, cardiomegaly, oedema of the lower limbs) and echographic criteria: alteration of the RF (shortening fraction). The data were entered in Excel and analysed using SPSS (Statistical Package for Social Sciences) Statistics version 25. The significance threshold was retained for a p-value < 0.05. Patients were initially hospitalised in the reception and emergency department for stabilisation before being transferred to the paediatric cardiology department for follow-up. The duration of follow-up will depend on the patient's progress and the type of heart disease.

Results
During the period of our study 894 patients were hospitalised, of whom 164 for heart disease and 38 for cardiogenic shock, i.e. a hospital prevalence of 4.2%.
Cardiogenic shock occurred in 23% of patients hospitalised for heart disease.
The mean age was 64 months with a standard deviation of 67, the sex ratio was 1.92 in favour of girls. Parental consanguinity was found in 16 (42%) of our patients. The socio-economic level of our patients was considered low in 28 patients (74%), 26 (68%) of the patients came from the suburbs of Dakar. The socio-demographic characteristics are summarised in Table 1. Heart disease was diagnosed before the onset of cardiogenic shock in 24 (89%) patients. Infection Open Journal of Pediatrics  Table 2). The most common type of heart disease was rheumatic heart disease in 12 (32%) of the patients ( Figure 1). The most common clinical signs were tachycardia, which was present in all our patients, as well as dyspnoea and cold extremities (

Discussion
During the study period, 894 patients were hospitalised at the CHNEAR reception and emergency department, including 164 for heart disease and 38 for cardiogenic shock, i.e. a hospital prevalence of 4.2%. This prevalence is comparable Open Journal of Pediatrics   These results are comparable to the results of Sylla et all in 2017 [6]. Dakar is the location of the CHNEAR which is a referral centre that polarises the population of Dakar and its suburbs. The socio-economic level was low in 73% of our patients. Azagoh-Kouadio et al. [7] found 61% of low socio-economic level in Côte d'Ivoire. Our results are in line with the literature which identifies low socio-economic level as a risk factor for the occurrence of acquired heart disease [8] [9]. Cardiogenic shock in children occurs most often in the presence of known heart disease [1] [10]. Indeed, in our series, 89% of the patients already had a known heart disease. However, we noted that 11% of our patients had no known cardiac disease. This could be explained by the number of under-diagnosed heart diseases linked to the lack of cardio pediatricians in Senegal.
In our series, the etiologies found are similar to the data found in the literature. stoppable blood pressure in 22% of patients [15]. The higher rate of impregnable blood pressure in the study could be explained by the fact that the majority of our patients came from the periphery, which delayed management. However, the recognition of cardiogenic shock is a diagnostic and above all a therapeutic emergency, as any delay in initiating appropriate treatment may lead to irreversible visceral damage. The presence of arterial hypotension is a sign of the advanced stage of cardiogenic shock in children [5].
The main therapeutic means used in our study were dobutamine and nora-

Conclusion
Cardiogenic shock is a diagnostic and therapeutic emergency. It is a rare pathology in the pediatrics setting with little data available, especially in developing countries. Its diagnosis is often late in our country and its mortality is still very high. The improvement of the mortality rate could be achieved by improving the technical platform and the training of health personnel.