Elsevier

Progress in Pediatric Cardiology

Volume 47, December 2017, Pages 39-43
Progress in Pediatric Cardiology

Review
Novel strategies for supporting challenging populations: Inpatient infant, developing toddler, successful school-age, & the autonomous adolescent

https://doi.org/10.1016/j.ppedcard.2017.08.003Get rights and content

Highlights

  • Pediatric device patients are heterogeneous, high-risk and low-volume.

  • Different ages and stages require appropriate growth and development considerations.

  • Care is complex and requires a multidisciplinary team approach.

  • Communication and collaboration with the team, patient, and family is key.

Abstract

Pediatric patients supported by ventricular assist devices form a growing and challenging population. They are high-risk, and heterogeneous (in terms of age, neurodevelopment stage, and underlying anatomy) and relatively low-volume. Standardization of care across the various ages and stages is difficult. Multidisciplinary teams managing these patients must have a good understanding of growth and development to provide optimal care and creative options for growth, development, and adherence in order to achieve improved outcomes for pediatric ventricular assist device patients.

Introduction

Pediatric ventricular assist device use is growing rapidly around the world, and with that comes many opportunities and challenges. According to Pedimacs, a national registry of pediatric ventricular assist device data, 37 hospitals across America utilize the database, and 241 patients were enrolled from September 2012 to December 2016 [1]. Caring for pediatric ventricular assist device patients is complicated in that there are many types of devices available to use in a very diverse population of patients ranging from infant through adolescent. As the use of ventricular assist devices becomes more commonplace, it is important to know how to manage these patients of all ages, stages, and anatomies.

Section snippets

Inpatient Infant

Infants have a high incidence of both congenital heart disease and cardiomyopathies. Congenital heart disease, the most common birth defect, affects nearly 1% of births, an incidence of around 40,000 annually in the US (of whom, 15,000 will require surgery early in life) [2]. Cardiomyopathies are less common, but infants less than 12 months old form the majority of 1 in 100,000 children in the U.S. [2]. Although the incidence of heart failure is high among infants, mechanical support is

Developing Toddler

As children transition from infancy to toddlerhood the rapid acquisition of growth and motor development slows in favor of tremendous advances in intellection, social, and emotional functioning. Normal development for the toddler includes: walking, running, feeding self, saying single words and then sentences, and playing with others [4]. Additionally, nutrition can offer challenges for the toddler as they learn about many different food groups and have an inconsistent diet. Toddlers move

Successful School-age

School-age child development, ages six to twelve, includes a lot of variability in growth and development [5]. Physical changes are apparent during this time, including onset of puberty, and with this comes more self-awareness. School-age children have smooth and strong motor skills but there remains much variability in their coordination, endurance, balance, and physical abilities. There can be large differences in height, weight and build among school-age children, and as early as the age of

Autonomous Adolescent

Adolescence, from ages 12 to 18, refers to the physical, psychosocial, and emotional transition from childhood to adulthood. During this time, children develop the ability to understand abstract ideas, establish and maintain relationships outside their family, have a more mature sense of self and purpose, and begin to question values while shaping their own identity [10]. Milestones to consider for this age group consist of: feeling a sense of belonging in a valued group, acquiring skills and

Conclusion

The pediatric ventricular assist device population covers a multitude of ages, stages, growth, and development. It is challenging to care for this heterogeneous population, and their families. When caring for these children, it is important to focus on providing age appropriate care, and integration of a multidisciplinary team who can help recognize and manage difficulties as they arise. Key concepts in caring for this high-risk, relatively low-volume population include communication and

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Authors declare there is no conflict of interest.

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