Postoperative complications that are likely to occur.
There are 2 complications that may occur within 1 month of discharge from the hospital, with low chances of occurrence after 1 month:.
1, pericardial effusion: frequent nausea and vomiting without any reason, heart ultrasound should be done as soon as possible, and if there is a large amount of fluid in the middle to the day, it should be drained out as fast as possible without delay, because it will affect the child’s blood pressure and heart rate, which can be life-threatening in serious cases. Nausea and vomiting may also be due to acute gastroenteritis (pulling and vomiting), viral infection (cold and fever, nausea and vomiting) or electrolyte disturbance (potassium and salt deficiency). If it’s not a pericardial effusion, you can go to the local hospital to have an urgent blood test for electrolytes, which has nothing to do with eating. If your child is potassium deficient, you can drink more potassium citrate; if you are salt deficient, eat a little saltier.
2, pleural effusion: manifested as breathing difficulties, shortness of breath, swollen face, fast breathing, purple lips, crying and irritability. You should immediately go to the local hospital to take a chest X-ray, and if there is a medium to large amount of pleural effusion on the day of examination, drain it out as fast as possible because it will affect the child’s respiratory function.
If a small amount of pericardial effusion or pleural effusion cannot be released, conservative treatment: 1.
1. Strictly control the amount of water intake to the limit of not killing the child by thirst.
2.Strengthen diuresis, the dose of diuretics should be increased.
3, buy anti-inflammatory drugs such as anti-inflammatory pain (drug name: indomethacin).
In the above situation, the first priority is to drain. If something is wrong, you can call the hospital in the afternoon, and the doctor will answer the consultation promptly.
In order to reduce the occurrence of pericardial effusion and pleural effusion, pay attention to drinking and eating, and do not overeat or eat.
Regarding the surgical incision.
The wound cannot be bathed after discharge from the hospital, the gauze is torn off on the 2nd day, and the wound can be washed 3 to 4 days after bringing it to dryness.
Chicken breast control device: If the wound is a median incision and the child is older than 6 months, it is recommended to use a chicken breast control device. Because the median incision is split in the middle of the sternum, the sternum is directly sutured with steel wire or sternum thread after the surgery, there will be pressure in the chest cavity, and the child will protrude the sternum if he has phlegm and cough. The lateral incision does not need a chicken chest control device.
Children under 6 months old buy or not, parents look at the situation themselves, because many children under 6 months old do not have timely supplementation of cod liver oil and calcium, the child’s sternum is very thin, some children’s bones are sunken. So if you want to buy it, you have to look at it first, the bones are indeed bulging, no depression before buying. If the skin at the wound looks flat and feels flat, you don’t need to buy it.
Tear off the tape and gauze on the 2nd day after discharge, keep the wound dry, and you can wear the chicken breast treatment device for 3-6 months. Wear it a little tighter, but don’t make the child’s skin red, don’t infect the wound by using it. Don’t let your baby sleep on his back when wearing it, sleeping on his back or side is fine. If the weather is hot, open it every day and look at it. You can wear it intermittently, but it is not as effective as wearing it continuously.
Scar film: about 2 weeks after surgery, once the scabs fall off, you can use it. If the wound is not wide and not higher than the skin (not keloid), you can stop using it. 1 patch can be used for 1 month, if the wound is still wide and red after patching, it means it is keloid, and you have to continue patching until the wound is flat and not higher than the skin and the color becomes white.
How to feed.
How to calculate the amount of intake and output for post-operative children.
Children weighing less than 10 kg: water intake: 80 ml/day/kg; if the child is hungry, small children with malnutrition, fair cardiopulmonary function, liver is not large and swollen, it can be increased to 100-120 ml/day/kg.
Children weighing 10-20 kg or less: children over 1 year old can eat rice, cookies, buns, etc. Bananas and apples are not counted in the water volume, but rice and pears are counted in the water volume.
After 1 month of surgery, if the liver is large, edema and poor heart and lung function, the intake should still be limited.
If you have strong diarrhea and diarrhea after eating Riengi, you should increase the amount of water you drink. If you have a lot of diarrhea, drink more water than the amount of diarrhea, to prevent your child from becoming dehydrated.
It is recommended that children under 4 months of age eat breast milk, because it contains various immune components. 6 months of age or older, the components in breast milk will become increasingly worse, and children over 4 months of age should add complementary foods, not just drink milk, drink how much milk is not full, you can add steamed egg custard, rice porridge, etc. 9 months of age can eat thin porridge, noodles, add some salt to eat. 1 year of age or younger children to soup noodles, minced meat porridge mainly. 2 years of age or older children chicken, duck, fish, shrimp, and meat. Children above 2 years old can eat chicken, duck, fish, meat and shrimp. More high protein foods should be consumed to promote wound healing.
How to review.
Four tests are performed 1 month or 5 weeks after discharge from the hospital.
The first one is to have the local pediatrician listen to the child’s lungs for any phlegm left in them. Within 1 month of discharge, cardiopulmonary function is adjusting. Many children may be discharged with temperatures fluctuating around 37 degrees, blood work may be 12,000 or 13,000, some children may have phlegm on their ears, and some children may have slightly larger livers. One month after discharge, the local doctor will decide whether the diuretics prescribed by the BID doctor can be reduced or not, and whether the vasodilators can be stopped or not, depending on the child’s cardiopulmonary function.
Secondly, listen to the child’s heart rate and rhythm.
Third, let the doctor feel the size of the child’s liver.
The fourth is to see if the child’s face, legs and feet are swollen.
Review in 1 (3) months at the surgical clinic.
[See the previous medication instructions for related medication adjustments].
A cardiac ultrasound, chest X-ray and electrocardiogram will be required 3 to 6 months after surgery. Babies from around Beijing can come directly to Fu Wai Hospital for review, while those from farther away can see a local doctor (cardiac surgeon or pediatrician). Children with endocardial cushion defects, tetralogy of Fallot, right ventricular double outlet, severe pulmonary hypertension, etc. are expected to be reviewed at Fu Wai Hospital at 3 or 6 months post-operatively; those who are more ill after 6 months are unlikely to return to normal and will need to be checked every 2 years.
Vaccination.
Vaccinations can be given 3 months after the surgery, and the ones that were missing before can be made up slowly one by one.
Any vaccination is a vaccine and has side effects. If your child is not feeling well, such as a cold, cough, fever, runny nose or diarrhea, you can’t get vaccinations and must postpone them until your child is fine. In Beijing, there have been 2 children with preexisting heart disease who died after vaccination.
Why is the vaccination scheduled after 3 months of age?
Because most of the children’s wounds have grown, cardiac diuretics have stopped, and the baby has recovered from the blow of surgery, so the preventive injection is more secure, but choose the time when the child’s condition is stable.
Regarding post-operative exercise.
Avoid strenuous exercise within six months and do not favor strenuous running. For some children with mild disease, such as small atrial defect or small ventricular defect, the wound may grow well more than a month after surgery, and the disease is very mild, and the child can’t control himself (love to play and run), so he really needs to run only after 3 months of normal review.
In order to reduce the number of colds and fevers, the less people visit your child at home, the better, and often open the windows to ventilate. 3 months later, if the child recovers, you can see more people. Avoid strenuous exercise for six months. You should get some sunshine and take a walk.
In case of a cold, you should treat it promptly, limit your child’s sports (especially competitive sports), rest more, and drink more water appropriately. Cold medicine and other medications for the heart can be taken at the same time. If the cold is a viral infection, then take ribavirin, and add vitamin C for 1 week (there may be gastrointestinal irritation) in a high dose, 10 tablets/day over 3 years of age.
Children with tetralogy of Fallot cannot run like normal children because of right ventricular hypertrophy and an enlarged heart, and should avoid strenuous exercise for 6 months. Most children with French IV will still have a heart murmur after surgery, but it is nothing too serious.