New hope for young hearts: A systematic review of sodium glucose cotransporter 2 inhibitors in pediatric heart failure

Current management of pediatric heart failure (HF) remains challenging. The emergence of sodium glucose cotransporter 2 inhibitors (SGLT2i) offers potential benefits beyond their traditional use in diabetes care. This review aims to provide a comprehensive perspective on the potential of SGLT2i to address pediatric HF. A literature search was conducted across PubMed/MedLine, Scopus, Cochrane Library, and gray literature repositories. This review included studies on SGLT2i use in pediatric HF, focusing on patients aged 18 or younger. The quality of the studies was independently assessed by four reviewers, with discrepancies resolved by consensus. A narrative synthesis was conducted to evaluate the clinical outcomes reported across the included studies. The protocol was registered in the Prospective Register of Systematic Reviews (CRD420251051396). Five studies were included in the analysis. Studies have reported an increase in ejection fractions and a decrease in natriuretic peptide levels following treatment with SGLT2i. Echocardiographic findings generally suggested a positive impact on the severity of ventricular dilation and atrioventricular valve regurgitation. There were no significant changes in the hemodynamic status, liver function, blood glucose, and electrolyte levels; however, we observed a notable decrease in glomerular filtration rate, an increase in serum creatinine, an elevated risk of acute kidney injury, protein-losing enteropathy, persistent abdominal pain, and urinary tract infection. SGLT2i offers therapeutic promise in pediatric HF with an acceptable safety failure. Preliminary data support further investigations to guide clinical adoption.