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AAP: Children with congenital heart disease require collaborative medical homes
An established medical home for children with congenital heart disease should include coordination between primary care physicians, family members and other health care specialists, according to a new policy statement issued by the AAP.
“Congenital heart disease is the most common birth anomaly,” M. Regina Lantin-Hermoso, MD, FAAP, FACC, from the section of cardiology in the department of pediatrics at Baylor College of Medicine, and colleagues wrote. “With advances in repair and palliation of these complex lesions, more and more patients are surviving and are discharged from the hospital to return to their families. Patients with [this condition] have complex health care needs that often must be provided by the PCP and medical home.”
According to the statement, the PCP should be aware of information regarding the specific diagnosis of infants, as well as interventions scheduled and completed, residual defects, involvement of other organ systems and observations noted at discharge. These observations should include weight, oxygen requirements and baseline saturations. Additionally, medication and feeding routines that fit into the family’s capabilities should be established.
Lantin-Hermoso and colleagues stress the importance of comprehensive routine vaccination for children with congenital heart disease because they may be more susceptible to infection. The researchers endorsed following the recommended schedule for 13-valent conjugate pneumococcal vaccine. Later doses of 23-valent polysaccharide vaccination should be administered to children with functional asplenia. Daily prophylaxis against encapsulated bacteremia using antibiotics may be warranted in children up to 5 years of age with heterotaxy and asplenia or nonfunctional polysplenia.
Other recommendations provided by Lantin-Hermoso and colleagues for the care of children with congenital heart disease include:
- Encourage coordination of care and communication with families, primary care and specialized care providers, especially during the transition from hospital to home and from pediatric to adult care;
- Promote organizational support for caregivers and identify stressors that may appear throughout the child’s life;
- Ease access to subspecialty care and medications for the child;
- Educate families and caregivers on CPR if their child has an increased risk of sudden death;
- Collect a complete and thorough history and examination of newborns with neonatal pulse oximetry to better identify critical congenital heart disease;
- When indicated, prescribe antibiotics for asplenia, prophylaxis for seasonal RSV in at-risk patients and influenza vaccines for patients and families. Become aware of risks associated with live-virus vaccines for patients with DiGeorge syndrome. Follow endocarditis prophylaxis regimens and promote dental hygiene.
- Support lifestyles that include good nutrition for infants and children, and encourage physical activity in children and adolescents. A prescription for exercise is suitable in most cases.
– by Katherine Bortz
Disclosure: The authors report no relevant financial disclosures.
