The Pediatric Cardiac Surgery Inquest Report



General issues

The first major difference between adult and pediatric patients arises from the disparity in their sizes. While this disparity becomes less of an issue with older and teenaged children, where younger children and neonates (at the HSC, those less than six weeks of age) are concerned, the size of bodies and organs is a significant factor. The common statement that 'your heart is approximately the size of your fist' takes on enormous significance when one considers the size of a newborn's fist. The size of a baby's heart, in fact, has been compared to the size of a peach pit.

A second major difference is that a child is less able (and sometimes less likely) than an adult to articulate his or her medical problems and concerns to a doctor. Infants, and other children who are unable to speak, present a particularly difficult issue. While a doctor can be guided by a description of symptoms from an adult in assessing a particular medical problem and in determining the best course of treatment, that guidance remains elusive where children are concerned. Thus the determination of a child's health problems relies more heavily on observation and examination than is the case with adults. Of necessity, great reliance is placed on second-hand information about issues, such as how the child is eating or behaving. This information is usually gathered from people who are not medically trained (such as those adults involved in the care of the child).

It is true that adult patients are sometimes unable to articulate their problems (because of physical or intellectual limitations and even for psychological reasons), but this is invariably the case with infants. Thus the person diagnosing the child's medical problems must not only exercise care and attention to detail, but also must pay great attention to what might be considered extraneous information.

These factors also place the parent or guardian of the child in a position of considerable dependency (and therefore of trust) on the medical practitioner or nurse, when it comes to assessing the child's condition and recommending a particular course of action.

Besides size and lack of ability to speak, infants present other differences too. These include anatomical (the structure of the body), physiological (how the body works) and pharmacological (how the body responds to drugs) differences.


An issue specific to cardiac cases

A major difference between adults and children arises in the area of cardiology and cardiac surgery. Children with cardiac problems tend to have congenital heart defects while adults tend not to have such defects. Additionally, no two children with the same type of cardiac lesion will present in exactly the same way, whereas adults with heart problems tend to have similar presentations. The anatomy of each congenital heart defect can differ significantly from one to the next, whereas adult hearts tend to appear the same, with medical problems that do not show anatomical differences.

The process of assessment and treatment of pediatric patients attempts to determine the anatomic anomalies unique to each child. Doctors treating children with heart problems have come to expect that, while in every case a child's cardiac defect can be categorized, what may be seen when a surgeon opens the child's chest can differ substantially from child to child. This may be so even when the children have the same category of defect.



Current Home - Table of Contents - Chapter 3 - General issues
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Previous Special Issues in Pediatric Medicine
Section 1 Chapter 1 - Introduction to the Issues
  Chapter 2 - Pediatric Cardiac Issues
  Chapter 3 - The Diagnosis of Pediatric Heart Defects and their Surgical Treatment
  Chapter 4 - The Health Sciences Centre
Section 2 Chapter 5 - Pediatric Cardiac Surgery in Winnipeg 1950-1993
  Chapter 6 - The Restart of Pediatric Cardiac Surgery in 1994
January 1, 1994 to May 17, 1994
  Chapter 7 - The Slowdown
May 17 to September 1994
  Chapter 8 - Events Leading to the Suspension of the Program
September 7, 1994 to December 23, 1994
  Chapter 9 - 1995 - The Aftermath of the Shutdown
January to March, 1995
Section 3 Chapter 10 - Findings and Recommendations
Appendix 1 - Glossary of terms used in this report
Appendix 2 - Parties to the Proceedings and counsel
Appendix 3 - List of witnesses and dates of testimony
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