Effect of Intravenous Phenobarbital on Left Ventricular Myocardial Contractility Determined by Echocardiography in Children

Introduction. Animal studies and rare human studies have suggesteda negative effect of barbiturates on cardiac function. Althoughintravenous (IV) phenobarbital is used routinely in children in theclinical setting, studies in children are lacking. We performed a studyto evaluate effect of IV phenobarbital loading on myocardial systolicfunction of children.Methods.xIn a prospective pilot study in children without congenitalheart defects, the effect of IV phenobarbital was evaluated on theleft ventricular systolic function measured by ejection fraction (EF)by Simpson’s method via an echocardiogram. Any child less than 18years of age who received IV loading dose of at least 20 mg/kg ofphenobarbital given as an infusion over 20 - 30 minutes for variousmedical indications was eligible to take part in the study. Three measurementsof EF by an echocardiogram were made: before loadingdose, 30 minutes after completion of the loading dose, and prior tothe first maintenance dose. Relevant clinical data were recorded,including vital signs, immediately prior to each echocardiogram.Change of function as measured by EF over time was analyzed usinglinear mixed modeling methods. For this study, significant change inblood pressure was defined as a drop of at least 20 mmHg in systolicblood pressure.Results. Ten children (70% female, age range two days to 8.2 years)were enrolled. Three had hypotension with a drop of systolic bloodpressure greater than 20 mmHg from baseline. On examining thetrajectory of EF on each individual graphically, the left ventricularEF tended to fall immediately following phenobarbital therapy andreturn to baseline on re-evaluation. These trajectories were statisticallysignificant for EF.Conclusions. Phenobarbital had a direct and transient depressanteffect on systolic function of the myocardium in one third of the cases.The depression in EF appeared to be transient with return to baseline in less than 24 hours. We recommend close monitoring with anticipationof decreased function in children when using IV phenobarbital.Kans J Med 2019;12(2):40-44

A Primer on Multimodal Imaging and Cardiology-Radiology Congenital Heart Interface

Pediatric cardiology imaging laboratories in the present day have several modalities for imaging of congenital and acquired cardiovascular disease. These modalities include echocardiography, cardiovascular magnetic resonance imaging, cardiac computed tomography and nuclear imaging. The utility and limitations of multimodal imaging is described herein along with a framework for establishing a cardiology-radiology interface

Familial aggregation of first degree relatives of children with essential hypertension

Purpose: Determining familial aggregation is an important first step in narrowing the search for disease-causing genes and hence we determined the familial aggregation of EH among first degree relatives of children with EH. Materials and methods: We prospectively enrolled children with EH along with their first degree relatives from a tertiary pediatric hypertension clinic in a large ambulatory care center. We utilized rigorous methodology for blood pressure (BP) measurements and diagnoses of EH to reduce the heterogeneity in the phenotype. For those enrolled, parental BP status was confirmed by in-clinic direct BP measurements. We also enrolled control children without EH along with their first degree relatives from the same pediatric ambulatory center. Results: In our case-control study of 153 families, the odds of having familial EH was more than 3 times higher among the cases than in controls (OR: 3.63, 95% CI: 1.85–7.12) with 71% of the cases and 41% of the controls reporting familial EH. One parent with EH was seen in 88% of the cases and 52% of the controls (OR: 6.92, 95% CI: 2.68–17.84). The odds of at least one parent (compared to neither) with EH was almost 7-fold higher, and odds of having two parents with EH was 14-fold higher among cases versus controls. The risk of EH did not go back from the first degree relative to the second degree relatives. Conclusions: We identified familial aggregation with an increased liability of childhood onset EH with parental EH. The risk of childhood onset EH is more than doubled in the presence of EH in both parents versus in a single parent. Prediction for childhood-onset EH is improved by obtaining a family history of EH in the first degree relatives