Prevalence of pulmonary hypertension in children with adenoid or adenotonsillar hypertrophy at the Kenyatta National Hospital

Abstract

Background: Adenotonsillar hypertrophy is a common condition in childhood, whose serious complications of pulmonary hypertension and cor-pulmonale are common and devastating but local prevalence is unknown. Objectives: To determine the prevalence of pulmonary hypertension in children with adenoid or adenotonsillar hypertrophy at Kenyatta National Hospital (KNH) and secondarily determine the clinical-radiological factors associated with pulmonary hypertension in these children. Methods: This was a cross sectional descriptive study in children aged 0-12 years attending ENT clinic and general pediatric wards at KNH. with clinician diagnosed adenoid hypertrophy confirmed on lateral neck radiography. Eligible patients were consecutively recruited into the study between September and November 2011. The patients were evaluated for symptoms. physical findings. lateral neck radiograph measurements of the adenoids. tonsils and airways; and Doppler echocardiographic assessment of systolic pulmonary artery pressure (sPAP). The paediatric radiologist and the cardiologist were blinded to the patients' severity of symptoms. Pulmonary hypertension was defined as mPAP of >25mmHg estimated by the Chemla equation (0.61 sPAP+ 2mmHg). Results: The prevalence of pulmonary hypertension in children with adenoid or adenotonsillar hypertrophy at KNH is 21.1 % (95% CI 14.3% to 29.4%). Independent factors associated with pulmonary hypertension include d'a1ly hyperactivity (OR= 0.22 [95% CI 0.06 to 0.87] p=0.03). oxygen saturation (OR= 0.72 [95% CI 0.54 to 0.97] p=0.03) and palpable P2 (OR= 9.84 [95% CI 3.2 to 55.4J p=O.O I). Mouth breathing singly or in combination with restless sleep on history showed the highest sensitiv~y (88.5%) and negative predictive value (86.4%) for pulmonary hypertension in these children. Conclusion and Recommendations: One in every 5 children with clinician diagnosed and radiologically confirmed adenoid or adenotonsillar hypertrophy at KNH had pulmonary hypertension. Clinical screening and echocardiography evaluation is vital for early identification and prevention of pulmonary hypertension.