Pediatric acute heart failure in the emergency rooms and general pediatric wards of low- and middle-income countries is a severe, congestion-dominated illness that strikes mostly infants and preschool-aged children, is frequently triggered by preventable conditions such as infection and severe anemia, and kills between roughly 3% and 40% of those hospitalized, according to a scoping review published in BMC Pediatrics. The review, which mapped the available evidence on the condition in emergency and acute-care settings across these countries, found that the evidence base itself is thin: 33 studies from 16 countries, most of them small, single-center observational reports.
The authors, led by Chibuike Daniel Onyejesi, followed Joanna Briggs Institute guidance and the PRISMA extension for scoping reviews, searching PubMed/MEDLINE, Global Index Medicus, and the Cochrane Library from inception through June 2026. They defined acute heart failure as new or worsening heart failure requiring unplanned acute hospital care, including acute decompensation of chronic heart failure. Primary studies reporting the condition among neonates, infants, children, and adolescents receiving unplanned acute hospital care in low- and middle-income countries were eligible. Data were charted across burden, clinical characteristics, etiology, diagnosis and triage, acute management, outcomes, and health-system and equity domains, and the results were synthesized narratively.
From 1,124 records identified, the 33 included studies came from 16 countries. Most were single-center observational studies; the median sample size was 42 children, and 18 studies enrolled fewer than 50 participants. Infants and preschool-aged children predominated across the cohorts, with the exception of rheumatic disease cohorts. Where severity was graded, 71% to 94% of children were in modified Ross or New York Heart Association class III–IV, meaning their heart failure was severe enough to produce symptoms with minimal activity or at rest.
The clinical picture was dominated by congestion rather than low output. Respiratory distress and hepatomegaly — a swollen, congested liver — were frequently reported features. The causes differed sharply by setting. In unselected emergency and general pediatric populations, infection and severe anemia commonly precipitated acute heart failure. In cardiology and intensive-care cohorts, by contrast, congenital heart disease, cardiomyopathy, myocarditis, and rheumatic disease predominated.
The burden on health systems was substantial. Where acute heart failure was ascertained in unselected pediatric admissions, it accounted for 4.0% to 10.8% of admissions; the review reports PICU and disease-specific estimates separately. All-cause in-hospital mortality ranged from 3.2% to 39.7%, with disease-specific cohorts reporting lower case fatality.
Diagnosis frequently depended on clinical criteria and basic investigations rather than advanced imaging. Access to echocardiography, specialist care, cardiac surgery, and mechanical circulatory support varied markedly across the settings studied.
The review’s conclusions depict pediatric acute heart failure in these settings as a severe condition that presents late, predominantly affects young children, and is often precipitated by conditions that are preventable or treatable. The authors call for urgent prospective multicenter studies at the initial point of contact, using standardized definitions, minimum datasets, and specified outcome periods.
The scoping review does not pool data statistically or estimate an overall burden; it maps what exists.
Subject of Research: A scoping review of the burden, clinical characteristics, management, and outcomes of pediatric acute heart failure in emergency and acute-care settings in low- and middle-income countries.
Article Title: Burden, clinical characteristics, management, and outcomes of pediatric acute heart failure in emergency and acute-care settings in low- and middle-income countries: a scoping review
Article References: Onyejesi, C. D., Nwankwo, E. P., Oboli, V. N., Bob-Ume, N. C., Taha, N. A., Berger, G., Saleem, N. U. A., Botchway, E., & Alsabri, M. (2026). Burden, clinical characteristics, management, and outcomes of pediatric acute heart failure in emergency and acute-care settings in low- and middle-income countries: a scoping review. BMC Pediatrics. https://doi.org/10.1186/s12887-026-08008-6
Image Credits: AI Generated
DOI: 10.1186/s12887-026-08008-6
Keywords: pediatric acute heart failure, low- and middle-income countries, scoping review, emergency care, congenital heart disease, severe anemia, in-hospital mortality, echocardiography, cardiomyopathy, late presentation, health systems, Burden
