IJCS | Volume 33, Nº4, July and August 2020

332 Guimarães & Guimarães Profile of a pediatric cardiac ICU Int J Cardiovasc Sci. 2020; 33(4):331-336 Original Article persistent arterial channel (PAC), atrioventricular septal defect (AVSD) and aorta-pulmonary window. Cyanotic congenital heart defects include decreased pulmonary flow and obstructive diseases with right-to-left shunt: tetralogy of Fallot, tricuspid atresia, pulmonary atresia with or without IVC, transposition of the great arteries (TGA) with pulmonary stenosis (PS), Enstein anomaly, TGA without IVC, hypoplastic left heart syndrome (HLHS), total anomalous pulmonary venous return (TAPVR), and complex heart diseases with PS. Cyanotic cardiac defects with normal flow and parallel circulation include TGA with IVC and common arterial trunk, mitral atresia, and complex heart diseases without PS are classified as cyanotic cardiac defects with pulmonary hyperflow and arteriovenous malformations. 3 Fetal echocardiography is an imaging test that has been used for the diagnosis of cardiac malformations. However, this test is not performed in all pregnant women, and complex heart diseases related to the arterial channel may not be detected by obstetric ultrasound. 4 In this regard, pulse oximetry has been recommended by the American College of Cardiology and the American Academy of Pediatrics since 2009 as the screeningmethod for critical congenital heart diseases. 5,6 In Brazil, it is estimated that 28 thousand new cases of congenital heart diseases are diagnoses per year. 7 Eighty percent of children with cardiac problems at birth will need some type of intervention. 2 Considering the number of surgical interventions required and the number of procedures actually performed, there has been a deficit of 65%, especially in the North and Northeast regions, with deficits of 93.5% and 77.4%, respectively. 8 Rheumatic carditis, the most common complication of rheumatic fever, is one of the most common heart diseases acquired during childhood in the world, and has been considered the main cause of heart disease among children in developing and developed countries. 9-13 The objective of the present study was to determine clinical and epidemiological profile of patients admitted to a pediatric cardiac intensive care unit (ICU) of a tertiary hospital inSalvador city, Brazil. This couldbeusedas abasis by tertiary care units to adapt to these conditions and for the development of governmental policies aimed at improving the health of children and adolescents with heart diseases. Methods This was a retrospective, cross-sectional study, based on analysis of medical records of patients admitted to a pediatric cardiac ICU of a tertiary hospital in Salvador, Brazil, during the period from January 2013 to December 2014. A total of 367 medical records of patients aged between 0 and 15 years, with diagnosis of congenital and acquired heart diseases, were included. Sixty medical records had incomplete admission or discharge forms and were excluded. Data were collected from the medical records using a specific form that included personal data (age, sex, nutritional status calculated by Z-score), place of origin, clinical and surgical diagnosis, treatment, time of extracorporeal circulation (ECC) and length of stay at the ICU. Patients with congenital heart diseases undergoing surgical intervention were classified using the Risk Adjusted Classification for Congenital Heart Surgery 1 (RACHS-1), which is an adjusted risk score for surgeries in congenital heart diseases, developed by Jenkins et al. 14 This instrument allows categorization of several surgical procedures that have similar hospital mortality into six levels. This study was approved by the ethics committee of the Hospital Ana Nery de Salvador/Bahia . Statistical analysis The variables of the study (age, sex, nutritional status, place of origin, diagnosis, time of ECC, treatment and hospital mortality) were presented in RACHS-1 categories and expressed as numbers and percentages. For the variables: length of hospitalization, time of ECC and age, mean and standard deviation were also calculated. Results were described in tables. All data were inserted into a database constructed using the Epidata 3.1 software and then transferred to the SPSS software version 20. To determine possible factors associatedwith hospital mortality, we used the Pearson’s chi-square Test. Adjusted association measures (odds ratio) were obtained by logistic regression model, and the level of statistical significance was set at 5%. Results A total of 367 patients were admitted to the pediatric cardiac ICU during January 2013 and December 2014, and 307 were included in the study (Table 1). Distribution of the types of treatment by congenital heart diseases is described in Table 2.