Ann M. Giesenhagen, D. Dunbar Ivy, John T. Brinton, Maxene R. Meier, Jason P. Weinman, Deborah R. Liptzin
University of Colorado and Children’s Hospital Colorado Anschutz Campus
United States
Journal of Pediatrics
J Pediatr 2019; 210: 106-111
DOI: 10.1016/j.jpeds.2019.02.028
Abstract
Objective: To describe the clinical features of children who presented to Children’s Hospital Colorado (CHCO) with High-Altitude Pulmonary Edema (HAPE). Study design: We performed a retrospective chart review in children discharged from CHCO (an elevation of 1668m) with a clinical diagnosis of HAPE and a chest radiograph consistent with non-cardiogenic pulmonary edema. Descriptive statistics were used to describe the demographics, presentations, and treatment strategies. Results: From 2004 to 2014, 50 children presented to CHCO who were found to have a clinical diagnosis of HAPE and a chest radiograph consistent with non-cardiogenic pulmonary edema. Most (72%) patients were male and most (60%) of the children in the study were diagnosed with classic HAPE, 38% with re-entry HAPE, and 2% with high altitude resident pulmonary edema. Elevation at symptom presentation ranged from 1840–3536 m. Patients were treated with a variety of medications, including diuretics, steroids, and antibiotics. Four patients were newly diagnosed with structural heart findings: 2 patients with patent foramen ovale and 2 with atrial septal defects. Eleven patients had findings consistent with pulmonary hypertension at the time of echocardiography. Conclusions: HAPE symptoms may develop below 2500m, so providers should not rule out HAPE based on elevation alone. Structural heart findings and pulmonary hypertension are associated with HAPE susceptibility and their presence may inform treatment. Inappropriate use of antibiotics and diuretics in children with HAPE suggest that further education of providers is warranted.
Category
High Altitude Pulmonary Edema
Age Focus: Pediatric Pulmonary Vascular Disease.
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes