Sepsis in Young Infant With Hypoplastic Left Heart Syndrome

Introduction Hypoplastic left heart syndrome (HLHS) is a congenital heart defect (CHD), where left-side heart structures are underdeveloped [1]. Around 2.6 % of the population is affected by this condition [2]. Most children with CHD have a higher risk of sepsis due to prolonged hospital stays, invasive devices, chronic hypoxia. Therefore, sepsis is one of the main causes of death in children with CHD [3,4]. Case Presentation A 3-year-old female, with recently surgically corrected HLHS and a history of rectal atresia, presented to pediatric emergency room due to high fever, vomiting and diarrhea. The patient was triaged as category 4 (low priority). During clinical examination the patient was tachycardic (183 beats/min.), had tachypnea (76 times/min.), saturation was 79 % without additional oxygen and sluggish bowel peristalsis was noted on auscultation. Gastrointestinal infection was suspected, and following parental request, the patient was discharged. The same night the patient stopped drinking, urinating, became lethargic. Blood work showed elevated leucocytes (20000 uL) and C reactive protein (CRB) (263,9 mg/L). The patient was hospitalized with possible sepsis diagnosis. Blood and urine culture were taken and empirical antibacterial treatment with ceftriaxone began. There was no response to the treatment: further elevation of CRB (371 mg/L) and leucocytes (28800 uL), and on blood culture gram-positive diplococcus were seen. Vancomycin was added and the patient was sent to Vilnius University Hospital Santaros Clinics, the department of cardiac surgery. Discussion The most common causes of sepsis in children with CHD are respiratory, urinary tract and gastrointestinal infections, caused by gram-positive bacteria. In majority of cases the outcome of sepsis in children with CHD are full recovery, organ failure and death [3,5,6]. Conclusions Sepsis can be lethal for up to 25% of children with CHD [3]. Effective organization of patient triage in emergency departments, early diagnosis and treatment are vital for reducing the risk of death [3,7].