Management of Cardiomyopathy in Pediatric Cardiology Unit at Assiut University Children Hospital (Clinical Audit)

Abstract
Background: This study aims to assess how much the staff in the Pediatric Cardiology Unit are sticking to the agreed upon unit's protocol in the management of children admitted with Dilated Cardiomyopathy (DCM). It is aiming also to compare the Cardiology Unit's agreed upon protocol to one of the international guidelines.
Methods: This audit was conducted on 25 children with Dilated Cardiomyopathy (DCM) admitted to Pediatric Cardi-ology Unit at Assiut University Children Hospital in the period between May 2015 and May 2016. The study included 20 males & 5 females. Their ages ranged from 3 months to 16 years.
Results: The prevalence of male sex was 80% and 20% of cases were females. Cases <3 years constituted 40% of cases. In 60% of cases the age was older than 3y up to 16 years of age; the number of cases presenting as first admission was 68% and in 32% of cases the admission was recurrent; carvidelol was used in 32% of children with DCM and in the rest of cases (68%) carvidelol was not used; amiodarone was used in 2 cases (8% of the cases): In one case it was used alone, and in the second case it was used in combination with propranolol.
The unit's protocol was followed in 100% of cases by staff members of the Cardiology Unit at Assiut University Children Hospital.
Regarding the difference between unit's protocol and Canadian guidelines: There were three main differences. The 1st one was the absence in the unit's protocol of taking family history of cases with DCM. This was emphasized in the Canadian guidelines. The 2nd difference was that in the unit's protocol amiodarone was the 1st drug of choice in cases of DCM with arrhythmia. The 3rd difference was the use of L-carnitine and aspirin regularly initially and for follow-up in all cases with DCM in the unit's protocol. This point was not mentioned in the Canadian guidelines.
Conclusion: Due to lack of genetic studies performed by Assiut University Children Hospital in cases with DCM, taking family history of cardiac diseases has been omitted by the staff of the unit. Taking family history of cardiac diseases will be emphasized in future researches.
This is because idiopathic DCM is now thought to have genetic basis in many cases. Furthermore, besides emphasizing taking a family history this study will recommend family cardiac screening by echocardiography to be done for all family members or at least for both parents and young sibling.