CLINICAL PROFILE, SHORT-TERM OUTCOMES AND ASSOICITED FACTORS OF NON-SURGICALLY MANAGED CONGENITAL HEART DISEASES IN PEDIATRICS PATIENTS AT ASELLA TEACHING AND REFERRAL HOSPITAL, ETHIOPIA

Abstract

Abstract Background: Congenital heart disease (CHD) is a leading cause of morbidity in children, particularly in low-resource settings where surgical intervention is limited. Understanding the clinical profile and short-term outcomes of non-surgically managed CHD is essential to guide care. Methods: A retrospective cohort study was conducted at Asella Teaching and Referral Hospital, Ethiopia, from March 2020 to February 2025 among 156 pediatric patients with CHD. Data on demographs, clinical presentation, CHD types, comorbidities, anthropometric status, hospital admissions, medical management, and six-month clinical outcomes , further reclassified poor outcome(Death and / or DAMA) and good outcome (improved discharged and / or referred after stabilization) were collected from medical records. Descriptive statistics summarized the findings, and multivariable logistic regression identified factors associated with poor outcomes. Results: The majority of patients were infants (<1 year, 46.8%) and from rural areas (69.2%), with slight male predominance (54.5%). Most were symptomatic (91.7%), presenting with fast breathing (75.2%) and feeding difficulties (55.9%). Acyanotic CHD predominated (82.1%), with ventricular septal defect most common (41.7%); cyanotic CHD accounted for 17.9%, predominantly Tetralogy of Fallot (15.4%). Moderate or severe malnutrition affected 50% of patients. Hospital admission occurred in 82.7%, mainly for heart failure (79.8%) and pneumonia (53.5%). Medical management, primarily furosemide (73%) and spironolactone (69.5%), was provided in 76.9% of cases. At six months, 76.9% had good outcomes, while 23.1% had poor outcomes. Down syndrome (AOR = 4.63, 95% CI: 1.15–18.61, p = 0.031, short (≤3 days) (AOR = 6.01, 95% CI: 1.02–35.54, p =0.049) or prolonged (>14 days) hospital stay (AOR = 7.41, 95% CI: 1.08–50.93, p = 0.042), and loss to follow-up (AOR = 0.13, 95% CI: 0.04–0.41, p = 0.001)were independent predictors of poor outcomes. Conclusion: Pediatric CHD patients managed non-surgically are mostly infants with high rates of malnutrition. Continuous follow-up, nutritional support, and attention to comorbidities such as Down syndrome are essential to improve survival and functional outcomes.