Heart failure occurs when your baby’s heart can’t pump blood effectively. It’s a serious medical condition with many causes, but many babies may be treated with medications, implantable devices, or surgery.
Heart failure happens in infants when their heart is unable to pump enough blood to give their body the oxygen it needs.
Heart failure is a fairly common chronic medical condition among older adults. However, heart failure in childhood is relatively rare, occurring in an estimated 0.9–7.4 per 100,000 children. Pediatric heart failure also has very different underlying causes from heart failure in adults.
Among children with heart failure, infants are the most frequently affected age group. Babies less than 12 months old account for more than half of pediatric heart failure hospitalizations.
Heart failure occurs when the heart cannot pump blood efficiently and effectively to nourish the body. Typically, your heart works in a careful, cooperative sequence along with your blood vessels, lungs, and blood supply.
The right side of your heart collects blood returning from your body via your veins and pumps it to your lungs to be oxygenated, to have oxygen added to the blood.
From the lungs, freshly oxygenated blood then flows to the left side of your heart, which pumps it out via your arteries to fuel the rest of your body.
In heart failure, you can have problems with the structure or function of one or both sides of the heart. There are many different pathways to heart failure.
Regardless of cause, infants with heart failure often experience a distinct collection of symptoms due to insufficient cardiac output.
Common signs and symptoms of heart failure in infants include:
- breathing problems, such as wheezing, grunting, rapid or labored breathing.
- feeding difficulties, such as prolonged feeds, difficulty sustaining/ finishing feeds
- reduced growth
- excessive sweating, particularly during feedings
- swelling of the extremities, eyelids, diaper area
- enlarged liver
- unusually pale or blue-gray skin, cool extremities
- marked fatigue, lethargy, or fussiness
- abnormally rapid or irregular heartbeats
Heart failure in infants has very different underlying causes from heart failure in adults.
In developed countries, congenital heart defects (CHDs) – structural changes in an infant’s heart – cause most cases of heart failure in infancy. These structural changes in the heart and central circulation are present from birth. Examples of CHDs that may commonly cause heart failure include:
- CHDs causing
single ventricle physiology, such as hypoplastic left heart syndrome (HLHS), tricuspid valve atresia, or pulmonary atresia - coarctation of the aorta
- large ventricular septal defects (VSD)
- anomalous left coronary artery from the pulmonary artery (ALCAPA)
Other causes of heart failure in infancy include:
- Cardiomyopathies: problems with the structure or function of the heart muscle, inflammation of the heart muscle
- Persistent arrhythmias: atypical heartbeats
- Infectious conditions: such as infective endocarditis, especially in developing countries
Given that congenital heart defects (CHDs) are the most common cause of pediatric heart failure, it’s unsurprising that infants born with certain types of CHD are at increased risk of developing heart failure.
Some forms of cardiomyopathy can run in families. For example, in up to
Other chronic medical conditions, such as HIV infection, thyroid disease, or inherited metabolic conditions, can make it more likely that infants will develop heart failure.
Sex at birth, race, or ethnicity do not appear to be independent risk factors for infant heart failure overall. One 2022 study found no sex, racial, or ethnic differences among pediatric heart failure hospitalizations in the United States.
First, your doctor will talk with you about your child’s symptoms, check your baby’s growth, and examine your baby.
When heart failure is suspected, your doctor might order these common tests:
- Blood tests: complete blood count, electrolytes, and markers of heart health like B-natriuretic peptide (BNP) or troponins
- Electrocardiogram (EKG): checks your baby’s electrical heartbeat rhythms
- Echocardiogram (ECG): an ultrasound that checks the heart’s structures and activity
- Chest X-ray (CXR): assesses heart size and lung health
Often, your infant’s doctor will refer you to a pediatric cardiologist. Sometimes, additional tests, like cardiac MRI or cardiac catheterization, may be needed.
The treatment of heart failure in infancy depends on the underlying cause. For example, surgery can correct some congenital heart conditions, and specific treatment may be available for some underlying causes of cardiomyopathy.
Medications
But in general, your baby’s doctor may recommend certain medications to treat heart failure symptoms, such as:
- ACE inhibitors, beta-blockers, and/or angiotensin receptor blockers (ARBs): these control blood pressure and reduce stress on the heart
- Diuretics: these help your baby’s body get rid of excess fluid
- Digoxin, inotropes, or both: these increase the strength and efficiency of heart muscle contractions
Devices
In rare cases, pacemakers may be needed to help control heart rhythm, or ventricular assist devices (VAD) might be used to stabilize and assist the heart muscle.
Surgery
In severe heart failure, a heart transplant may be recommended.
The outlook for infants with heart failure depends greatly on the underlying cause. The good news is that some cases of heart failure are entirely reversible.
For example, some congenital heart defects can be repaired with surgery. Rare underlying causes of cardiomyopathy, such as vitamin deficiencies or thyroid disease, are reversible with medication or treatment. And in acute heart failure due to viral myocarditis, the heart muscle may recover after a period of supportive care.
But often, heart failure in infants becomes a chronic progressive condition, requiring ongoing support and treatment.
Still, there is reason for hope. Research has shown that pediatric heart failure may be different from adult heart failure at a molecular level, opening the door to ongoing studies of more targeted, effective therapies. And even in the most severely affected babies, median survival after heart transplant is over 20 years.
Signs of heart failure in infancy can include feeding difficulties and reduced growth, abnormal heartbeats, breathing problems, unusual sweating, and skin color and temperature changes.
It depends on the underlying cause of heart failure.
If your baby has a known risk factor for heart failure, such as a congenital heart defect or genetic mutation, your doctors may be able to closely monitor your child before symptoms arise.
Frequent growth and development checks, along with fortified feeds if needed, can ensure your baby stays on track.
With regular heart screening tests, doctors may be able to detect and treat the earliest signs of heart failure before it becomes symptomatic. When appropriate, they may even be able to intervene surgically.
Babies with heart failure often experience delayed growth and development.
This is thought to be due to difficulties with feeding, increased caloric needs, and sometimes lower blood oxygen levels. Stress and frequent or prolonged hospitalizations may also play a role.
Your baby’s care team can help monitor, prevent, and treat these problems.
Pediatric heart failure is a relatively uncommon but quite serious diagnosis.
In developed countries, inborn conditions like congenital heart defects and heritable cardiomyopathies are common causes of heart failure in children. For this reason, infants are the most frequently affected age group.
When your baby has a known risk factor or develops symptoms suggestive of heart failure, your doctor will order screening tests and refer you to a pediatric cardiologist.
Sometimes, heart failure in infancy has an acute or reversible cause – like a reversible arrhythmia, infection, or surgically correctible heart defect. However, heart failure in infancy can also become a chronic and progressive disease.
The good news is that treatment is available, and advances in care are ongoing.
A comprehensive, multidisciplinary pediatric heart failure team can help manage your child’s symptoms and support cardiac function. When necessary, your doctor can help you decide on more definitive treatments like cardiac surgery, implantable devices, or heart transplantation.