This article is part one of a two-part series on paediatric cardiology, with the second part, a CPD article, due to feature in the May issue of the IPU Review.
In part one of this two-part series, we will cover:
The heart is the most common organ affected by a congenital abnormality due to its complex development in utero. In Ireland, just under 1 per cent of newborns are diagnosed with a cardiac defect, equating to approximately 500-600 new cases of congenital heart disease (CHD) each year. For many of these children, ongoing management may include interventional procedures such as cardiac catheterisation or surgery.
The diagnosis of congenital heart disease (CHD) is increasingly made before a baby is born. In most situations the diagnosis of congenital heart disease is first suspected at the 20-week anatomy scan typically performed in a local maternity unit. Where abnormalities are detected, referral to a specialist foetal cardiology service allows for further assessment and care planning prior to delivery.
Cardiac development occurs around the fifth week of gestation — often before pregnancy is confirmed. In most cases, the underlying cause of CHD remains unclear despite investigation. However, there are a number of factors which are known to increase the risk of having a baby with a heart problem. There may be an anomaly in the baby’s genetic makeup, which has caused the heart defect. The baby may have an extra cardiac abnormality, for example, a bowel or a kidney problem that is known to increase the risk of heart disease. Sometimes these anomalies occur in predictable patterns and are called genetic malformation syndromes. A family history of CHD, either in a parent or a previous child, also increases risk, suggesting a genetic contribution that is not yet fully understood. Additionally, certain maternal medications and chronic health conditions may carry a small but recognised risk.
Cardiology and cardiothoracic surgery work hand-in-hand to provide a patient and family-centred service for children with heart disease. The cardiothoracic surgery department at Children’s Health Ireland at Crumlin is the national program serving the whole population of the island of Ireland. The National Paediatric Cardiothoracic Surgical Programme is centralised at CHI and provides cardiology services to all children born on the island or Ireland. It works in partnership with centres in Northern Ireland and regional hospitals. The goal is to ensure every child born with congenital heart disease in Ireland can access specialist cardiology care and ensures services are provided as close to home as possible.
The Centres include:
Hospital where PEC services are located on the island of Ireland:
The 27-bedded Children’s Heart Centre (CHC) ward is based in Children’s Health Ireland (CHI) Crumlin and is the national tertiary referral centre for paediatric cardiology and cardiothoracic surgery. It provides comprehensive, multidisciplinary care for neonates, infants, children, and adolescents with congenital heart disease (CHD) and acquired cardiac conditions.
There is a six-bedded cardiac day unit also attached which cares for patients pre and post cardiac catheterisaton, and for patients undergoing cardiac investigations such as CT, MRI patients and sedated echocardiograms.
Many patients will require cardiac surgery. Postoperatively, patients are transferred to the paediatric intensive care unit (PICU) for stabilisation and invasive monitoring before to the CHC ward for ongoing medical and pharmacological optimisation. Within the CHC ward, care focuses on postoperative recovery, medication optimisation, parental education, and coordinated discharge planning.
The cardiology pharmacist plays a key role in supporting safe and effective care by ensuring accurate prescribing, dose verification, and medication reconciliation, as well as providing education to parents and caregivers. The cardiology pharmacist also liaises closely with community pharmacies to facilitate ongoing medication supply and reimbursement, supporting continuity of care following discharge.
Paediatric cardiology is the medical speciality which diagnoses and treats infants, children and adolescents with congenital heart disease (CHD) and acquired cardiac conditions. Unlike in adults, paediatric cardiology is primarily congenital or inherited. CHD refers to structural or functional abnormalities of the heart or great vessels present from birth, with presentations ranging from minor septal defects to complex single-ventricle physiology. Advances in early diagnosis, surgical techniques, and medical management have significantly improved survival, resulting in a growing population of children and adults living with repaired or palliated heart disease.
Heart failure in this population may arise from structural defects, cardiomyopathies, or postoperative ventricular dysfunction. Symptoms can include tachypnoea, poor feeding, hepatomegaly, and failure to thrive.
Management of CHD often involves staged surgical interventions aimed at restoring normal or near-normal physiology. Common procedures include:
Medication use in paediatric cardiac patients is highly individualised. Pharmacists must be familiar with fluid restrictions, weight-based dosing, and drug stability issues.
Key drug categories include:
Considerations need to be given to the following when clinically checking medications;
On discharge from CHC, children typically transition to oral therapy. Common discharge medications include:
Prior to discharge, CHI pharmacists are involved in ensuring parents understand dosing intervals, administration techniques, and potential adverse effects (for example, hypotension, hyperkalaemia).
In part 2 of this series we will look at:
Aoibhe Frazer MPSI
Senior Pharmacist, Pharmacy Department Children’s Health Ireland (CHI), Crumlin
Highlighted Articles
