Post-Discharge Care for Children After Congenital Heart Surgery

Children who have undergone surgery for congenital heart disease require careful attention during the early recovery phase after hospital discharge. While each case varies depending on the specific condition and type of surgical intervention, there are several general care guidelines that can help parents support their child's recovery effectively.

Once a child is discharged, they will typically continue with oral medications and scheduled outpatient follow-ups. It's natural for families to feel anxious after leaving the hospital environment, but it's important to remain calm and confident. The medical team would not discharge the child unless they were past the immediate post-operative risks. That said, vigilance is still necessary to ensure a smooth recovery.

Medication Management

Before discharge, the hospital pharmacist will provide detailed instructions on medication usage. Each child's regimen may differ based on their surgery and condition. It's crucial to follow the prescribed schedule and dosage carefully.

Common medications include digoxin (a cardiac stimulant), furosemide and spironolactone (diuretics), enalapril and captopril (vasodilators), potassium supplements like potassium chloride, anti-inflammatory drugs such as prednisone and indomethacin, pulmonary hypertension treatments like sildenafil or vardenafil, and anticoagulants including aspirin and warfarin.

When taking digoxin or furosemide, potassium supplements are often required. Digoxin should be taken every 12 hours, with heart rate monitored before each dose. If the heart rate is too slow, the dose should be skipped. Calcium supplements should not be taken concurrently with digoxin. Captopril is usually given every 8 hours. Enalapril or captopril should be spaced at least 1–2 hours apart from diuretics to avoid hypotension. Bosentan requires regular liver function monitoring. Indomethacin should be taken after meals to reduce gastrointestinal discomfort. Warfarin users must have their coagulation levels checked regularly and adjust dosages as advised by the doctor.

Nutrition and Fluid Intake

Proper nutrition plays a key role in post-surgery recovery. For the first month after surgery, children should follow a low-fat, low-salt diet with controlled fluid intake. Excessive fluid can strain the heart and slow recovery, so it's important to adhere to the recommended daily fluid limits provided by the medical team.

Older children can gradually return to a regular diet, focusing on lean proteins like chicken or eggs, along with fruits and vegetables. Meals should be small to avoid discomfort and reduce cardiac strain. High-fat broths, such as bone or fish soup, should be avoided.

Incision Site Care

The surgical wound requires careful attention. Typically, stitches are removed 10–14 days after the chest tube is removed, during a follow-up visit at the thoracic surgery clinic. Until then, regular dressing changes should be done every 2–3 days at a clinic or hospital.

Once the stitches are removed, the wound should remain dry for at least one week. If the area is healed, dry, and free of discharge after a week, the child can begin showering gently.

Scar Management

Scar-reducing silicone sheets can be applied one week after stitch removal, once the child is able to shower. Begin by wearing the patch for 5 hours on the first day, then remove it and check for any signs of irritation or allergic reaction. If none occur, gradually increase the wear time by 2–3 hours per day until reaching 15–20 hours daily.

If the patch becomes soiled or sweaty, rinse it with water and allow it to air dry before reuse. Each patch should be used for one month before replacing it with a new one.

Monitoring for Complications

Parents should be vigilant for any signs of complications. In addition to checking heart rate before each digoxin dose, watch for symptoms like persistent fever, vomiting, refusal to eat, irritability, or abdominal pain in older children. These may indicate pericardial effusion, which can develop due to post-pericardiotomy syndrome combined with improper diet.

If any of these symptoms appear, contact your physician immediately. A cardiac ultrasound may be necessary to assess the presence and severity of fluid around the heart. While small to moderate effusions can often be managed with medication and diet, severe cases may require emergency drainage to prevent life-threatening cardiac compression.

Follow-Up Appointments

Regular follow-up visits are essential. The typical schedule includes appointments at 1, 3, 6 months, and 1 year post-discharge. These visits allow the surgical team to monitor recovery and make any necessary adjustments to medication or lifestyle recommendations. If any concerns arise before the next scheduled visit, contact the surgeon's office for an earlier appointment.

Final Thoughts

It's important to remember that congenital heart disease and its treatments vary widely, so not every child will have the same recovery path. However, these general guidelines can serve as a helpful reference for families navigating the early post-discharge period. Always follow the specific instructions provided by your child's medical team for the best possible outcome.