Maintenance of the Infant or Child with End Organ Failure

Abstract

Organ dysfunction in infants and children often occurs due to congenital defects as either malformations (genetically based) or deformations (developmentally based). Though most of these congenital defects are identified in either the newborn or early infancy period some may be missed and manifest themselves later in childhood. Providing care for children with congenital defects and a failing organ often is more complex because of comorbidities of an overall genetic syndrome. Management goals must include not only maintenance of organ function as is the case in care of the adult with a failing organ, but also the requirement that assiduous attention be given to the child’s growth and development. This attention is needed both for its own sake of normalizing biometrics and psychic evolution but also because it enhances the child’s health, slows progression of organ dysfunction, and improves the outcome at the time of solid organ transplantation. Older children with acquired causes of organ failure present additional challenges to the childcare taker. While growth and development still require attention, the dramatic alteration that has occurred in the child’s life because of a failing organ is more pressing for the child and his/her parents. The adolescent who may have nearly achieved adult size and maturation and so less in need of attention to support growth and development is confronted with the stark reality of being different from his/her peers at a time when being like one’s peers has immense importance. Such things require consideration while support of the failing organ and the child’s overall wellbeing remains central.