Pneumonia among Children with Congenital Heart Disease: Patterns by Shunt Type in A Tertiary Hospital in Indonesia

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Congenital heart disease (n=134). Intervention: Acyanotic congenital heart disease (left-to-right shunt) vs. Cyanotic congenital heart disease. Primary outcome: Occurrence of pneumonia (PR 1.57, p=0.066).

Q: What does this research mean for the field?

Children with acyanotic congenital heart disease show a higher but statistically non-significant prevalence of pneumonia compared to those with cyanotic defects. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Aris Bayu Retnaningsih Alisyah Maria; Putri Amelia; Fathia Meirina; Juliandi Harahap; Lily Irsa; Olga Rasiyanti Siregar

doi:10.37287/ijghr.v8i3.1297

June 14, 2026Indonesian Journal of Global Health ResearchOpen Access

Pneumonia among Children with Congenital Heart Disease: Patterns by Shunt Type in A Tertiary Hospital in Indonesia

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Key result

Acyanotic congenital heart disease showed a higher but non-significant prevalence of pneumonia compared to cyanotic CHD (40.3% vs 25.4%; PR 1.57; p=0.066) among 134 pediatric patients.

Why the study?

Pneumonia risk in pediatric CHD is influenced by shunt type, defect size, and nutritional status, yet local data in Indonesia regarding these associations remained limited.

Does acyanotic congenital heart disease or larger defect size increase the risk of pneumonia in children with congenital heart disease?

Key Points

To determine the incidence of pneumonia in children with congenital heart disease (CHD) and analyze its association with cardiac shunt type and defect size.
Conducted a retrospective cross-sectional review of 134 echocardiography-confirmed inpatient and outpatient medical records of children with CHD treated at Adam Malik General Hospital from January 2022 to December 2024.
Extracted demographic characteristics, nutritional status, shunt classification (acyanotic vs. cyanotic), and acyanotic defect size (large: > 6 mm vs. moderate-to-small).
Analyzed clinical and radiological pneumonia diagnosis associations using Chi-square or Fisher’s exact tests and calculated prevalence ratios (PR).
Pneumonia was identified in 32.8% (44/134) of children with congenital heart disease.
Children with acyanotic CHD showed a higher proportion of pneumonia than those with cyanotic CHD (40.3% vs. 25.4%; PR 1.57; p = 0.066), though the association was not statistically significant.
Among patients with acyanotic CHD, pneumonia occurred more frequently in those with large defects than in those with moderate-to-small defects (47.0% vs. 38.0%; PR 1.24; p = 0.511).

Study Design

Type

Cross-Sectional (n=134)

Multicenter

No

Structured PICO

Does acyanotic congenital heart disease or larger defect size increase the risk of pneumonia in children with congenital heart disease?

P

Population

134 children aged 3 months to 18 years (40.3% female) with echocardiography-confirmed congenital heart disease treated at a tertiary hospital in Indonesia from January 2022 to December 2024.

E

Exposure

Acyanotic congenital heart disease (left-to-right shunt lesions, n=67) and large defect size (>6 mm, n=17 within acyanotic group)

C

Comparator

Cyanotic congenital heart disease (right-to-left shunting or complex mixing physiology, n=67) and moderate-to-small defect size (3-6 mm or <3 mm, n=50 within acyanotic group)

O

Outcome

Occurrence/incidence of pneumonia (defined as documented clinical diagnosis supported by compatible symptoms such as fever, cough, tachypnea, or respiratory distress, physical examination findings, and radiological evidence on chest imaging)hard clinical

Main Result

Relative Risk: 1.57

Absolute Event Rate: 40.3% vs 25.4%

p-value: p=0.066

Limitations

Retrospective cross-sectional design precludes causal inference and limits assessment of temporal relationships.
Absence of a control group of children without congenital heart disease.
Potential confounders such as immunization status, socioeconomic factors, environmental exposures, and timing of cardiac intervention could not be fully controlled.
Limited sample size.
Retrospective cross-sectional design precludes causal inference and limits the ability to assess temporal relationships between CHD characteristics and pneumonia occurrences
Absence of a control group of children without CHD prevents estimation of relative risk compared with the general paediatric population
Potential confounders such as immunisation status, socioeconomic factors, environmental exposures, and timing of cardiac intervention could not be fully controlled
Limited sample size

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Implication

Nearly one-third (32.8%) of children with congenital heart disease at an Indonesian tertiary hospital experienced pneumonia, with a non-significant trend toward higher risk in those with acyanotic left-to-right shunts and larger cardiac defects.

Abstract

Congenital Heart Disease (CHD) in children is frequently associated with lower respiratory tract infections, particularly pneumonia. Pneumonia risk in CHD is influenced by shunt type, defect size, nutritional status, yet local data regarding these associations remains limited. To determine the incidence of pneumonia in children with CHD and to analyze its association with shunt type and defect size. This retrospective cross-sectional study consecutively extracted demographic and clinical data—including CHD shunt type and defect size, nutritional status, and pneumonia diagnosis—from 134 echocardiography-confirmed medical records of hospitalized and outpatient pediatric CHD treated at Adam Malik General Hospital, Medan, from January 2022 to December 2024. Data associations were analyzed using Chi-square or Fisher’s exact tests, and prevalence ratios (PR) were calculated. Pneumonia occurred in 32.8% (44/134) of children with CHD. A higher proportion of pneumonia was observed in acyanotic CHD compared with cyanotic CHD (40.3% vs. 25.4%; PR 1.57; p = 0.066). Among acyanotic CHD, pneumonia was more frequent in children with large defects than in those with moderate to small defects (47.0% vs. 38.0%; PR 1.24; p = 0.511). Pneumonia is a frequent complication in children with CHD. Acyanotic CHD and larger defect size show a tendency toward increased pneumonia risk, although no statistically significant associations were identified.

Discussion

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Cite This Study

Maria et al. (2026) conducted a cross-sectional in Congenital heart disease (n=134). Acyanotic congenital heart disease (left-to-right shunt) vs. Cyanotic congenital heart disease was evaluated on Occurrence of pneumonia (PR 1.57, p=0.066). Acyanotic congenital heart disease showed a higher but non-significant prevalence of pneumonia compared to cyanotic CHD (40.3% vs 25.4%; PR 1.57; p=0.066) among 134 pediatric patients.

synapsesocial.com/papers/6af0db863c845ca7837ced85 https://doi.org/10.37287/ijghr.v8i3.1297

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Pneumonia among Children with Congenital Heart Disease: Patterns by Shunt Type in A Tertiary Hospital in Indonesia

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Pneumonia among Children with Congenital Heart Disease: Patterns by Shunt Type in A Tertiary Hospital in Indonesia

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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