{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:56:39Z","timestamp":1790088999315,"version":"4.0.1"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Congenital heart disease (CHD) is one of the main causes of hospital admissions and infant mortality, especially in developing regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study aims to describe the epidemiological and clinical features of CHD in pediatric patients, from one of the largest tertiary-level national referral pediatric hospitals in Ecuador.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>An epidemiological, retrospective cohort study was conducted among patients with CHD who were hospitalized at \u201cHospital Baca Ortiz\u201d between January 2019 to December 2022 in Quito, Ecuador.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1,000 pediatric patient medical records were reviewed from 2019 to 2022. Among these patients, 56.0% were female, and 65.2% resided at high altitudes (2,500\u20133,500\u202fm). Most cases (71.4%) were acyanotic CHD, with patent ductus arteriosus being the most prevalent (48.7%). Among cyanotic CHD, Tetralogy of Fallot was predominant (28.1%). Mortality was observed in 5.3% of patients, with a higher rate among acyanotic CHD (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Most cases of CHD were of the acyanotic type, predominantly affecting female patients. Although most cases occurred in children living above 2,500 meters, no clear influence of altitude on specific types of CHD was found. While mortality related to CHD was low, the burden of disability from these conditions was significant among patients with acyanotic CHD.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1497253","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T05:24:24Z","timestamp":1738128264000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Epidemiological characterization of congenital heart disease at different altitudes in Ecuador: a four-year retrospective study in a pediatric referral hospital"],"prefix":"10.3389","volume":"13","author":[{"given":"Juan S.","family":"Izquierdo-Condoy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian D.","family":"Arias-Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter I.","family":"D\u00edaz-Chamba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego A.","family":"Mena-Noro\u00f1a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lizbeth Cueva","family":"Toaquiza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beanjuly","family":"Esp\u00edn-Sambache","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia J.","family":"Valdivieso-Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Cangas-Isacaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Garc\u00eda-Ca\u00f1arte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Rubio-Niera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esteban","family":"Ortiz-Prado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/S2352-4642(19)30402-X","article-title":"Global, regional, and national burden of congenital heart disease, 1990\u20132017: a systematic analysis for the global burden of disease study 2017","volume":"4","author":"Zimmerman","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"141","DOI":"10.5830\/CVJA-2013-028","article-title":"The global burden of congenital heart disease","volume":"24","author":"Hoffman","year":"2013","journal-title":"Cardiovasc J Afr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1093\/ije\/dyz009","article-title":"Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies","volume":"48","author":"Liu","year":"2019","journal-title":"Int J Epidemiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1161\/01.cir.43.3.323","article-title":"Congenital heart disease in 56,109 births","volume":"43","author":"Mitchell","year":"1971","journal-title":"Incidence Nat His Circul"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1007\/s12013-015-0551-6","article-title":"Congenital heart disease: causes, diagnosis, symptoms, and treatments","volume":"72","author":"Sun","year":"2015","journal-title":"Cell Biochem Biophys"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"117","DOI":"10.5830\/CVJA-2013-015","article-title":"Pattern of congestive heart failure in a Kenyan paediatric population","volume":"24","author":"Ogeng","year":"2013","journal-title":"Cardiovasc J Afr"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1177\/000992280204100903","article-title":"Risk factors in congenital heart disease","volume":"41","author":"Roodpeyma","year":"2002","journal-title":"Clin Pediatr (Phila)"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1186\/s12887-021-02935-2","article-title":"Characteristics of in-hospital mortality of congenital heart disease (CHD) after surgical treatment in children from 2005 to 2017: a single-center experience","volume":"21","author":"Zheng","year":"2021","journal-title":"BMC Pediatr"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1186\/s12872-020-01781-x","article-title":"Global prevalence of congenital heart disease in school-age children: a meta-analysis and systematic review","volume":"20","author":"Liu","year":"2020","journal-title":"BMC Cardiovasc Disord"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"E32","DOI":"10.1542\/peds.107.3.e32","article-title":"Racial and temporal variations in the prevalence of heart defects","volume":"107","author":"Botto","year":"2001","journal-title":"Pediatrics"},{"key":"ref11","author":"Paucar","year":"2023"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1089\/ham.2019.0110","article-title":"High altitude as a cause of congenital heart defects: a medical hypothesis rediscovered in Ecuador","volume":"21","author":"Gonz\u00e1lez-Andrade","year":"2020","journal-title":"High Alt Med Biol"},{"key":"ref13","year":"2023"},{"key":"ref14","year":"2022"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"d4943","DOI":"10.1136\/bmj.d4943","article-title":"Acute altitude illnesses","volume":"343","author":"Imray","year":"2011","journal-title":"BMJ"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1177\/2047487318812502","article-title":"High prevalence of congenital heart disease at high altitudes in Tibet","volume":"26","author":"Chun","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"102","DOI":"10.14410\/2022.14.2.ao.16","article-title":"Incidencia de cardiopat\u00edas cong\u00e9nitas en poblaci\u00f3n adulta en el Hospital de Especialidades Jos\u00e9 Carrasco Arteaga\u2014Cuenca entre 2015 y 2020: Incidence of congenital heart disease in adult population at Hospital de Especialidades Jos\u00e9 Carrasco Arteaga\u2014Cuenca between 2015 and 2020","volume":"14","author":"Robles Lituma","year":"2022","journal-title":"Rev Med HJCA"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1186\/s12872-018-0968-0","article-title":"The incidentally diagnosed adult congenital heart disease during routine medical health checkups in 27,897 Koreans at a single center over seven years","volume":"18","author":"Kwag","year":"2018","journal-title":"BMC Cardiovasc Disord"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s43044-021-00133-0","article-title":"Pattern of congenital heart disease among Egyptian children: a 3-year retrospective study","volume":"73","author":"Al-Fahham","year":"2021","journal-title":"Egypt Heart J"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e21196","DOI":"10.7759\/cureus.21196","article-title":"Prevalence and pattern of congenital heart disease among children in Khartoum state, Sudan: a reflection of the current cardiac profile","volume":"14","author":"Abdelrahman","year":"2022","journal-title":"Cureus"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3389\/fcvm.2022.815137","article-title":"Epidemiology of congenital heart disease in Jinan, China from 2005 to 9: a time trend analysis","author":"Zhang","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e1178","DOI":"10.1002\/hsr2.1178","article-title":"Prevalence of congenital heart disease according to the echocardiography findings in 8145 neonates, multicenter study in southern Iran","volume":"6","author":"Parvar","year":"2023","journal-title":"Health Sci Rep"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"265","DOI":"10.5830\/CVJA-2014-055","article-title":"Congenital heart disease in the Niger Delta region of Nigeria: a four-year prospective echocardiographic analysis","volume":"25","author":"Otaigbe","year":"2014","journal-title":"Cardiovasc J Afr"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"148","DOI":"10.7705\/biomedica.v38i0.3381","article-title":"Epidemiology of congenital heart diseases in Bogot\u00e1, Colombia, from 2001 to 2014: improved surveillance or increased prevalence?","volume":"38","author":"Tassinari","year":"2018","journal-title":"Biomedica"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"288","DOI":"10.5539\/gjhs.v8n10p288","article-title":"Prevalence of congenital heart disease: a single center experience in southwestern of Iran","volume":"8","author":"Nazari","year":"2016","journal-title":"Glob J Health Sci"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1007\/s10995-009-0442-9","article-title":"Is the prevalence of specific types of congenital heart defects different for non-Hispanic white, non-Hispanic black and Hispanic infants?","volume":"14","author":"Nembhard","year":"2010","journal-title":"Matern Child Health J"},{"key":"ref27","year":"2013"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.ihj.2015.12.015","article-title":"Relationship of high altitude and congenital heart disease","volume":"68","author":"Hasan","year":"2016","journal-title":"Indian Heart J"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/0735-1097(88)90378-6","article-title":"Prevalence of congenital cardiac anomalies at high altitude","volume":"12","author":"Miao","year":"1988","journal-title":"J Am Coll Cardiol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"37","DOI":"10.24875\/ACM.21000325","article-title":"Prevalence of congenital heart disease in relation to height above sea level in a region of Colombia","volume":"93","author":"G\u00f3mez-Monroy","year":"2023","journal-title":"Arch Cardiol Mex"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e19188","DOI":"10.1016\/j.heliyon.2023.e19188","article-title":"Analysis of congenital heart disease research: mapping impact, production and global collaboration","volume":"9","author":"Zila-Velasque","year":"2023","journal-title":"Heliyon"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1017\/S204017441300010X","article-title":"Developmental programming of cardiovascular disease by prenatal hypoxia","volume":"4","author":"Giussani","year":"2013","journal-title":"J Dev Orig Health Dis"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1152\/japplphysiol.00321.2017","article-title":"Measuring high-altitude adaptation","volume":"123","author":"Moore","year":"2017","journal-title":"J Appl Physiol (1985)"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2967","DOI":"10.2741\/2286","article-title":"High-altitude hypoxia and preeclampsia","volume":"12","author":"Zamudio","year":"2007","journal-title":"Front Biosci"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1089\/152702903322022767","article-title":"Fetal growth restriction and maternal oxygen transport during high altitude pregnancy","volume":"4","author":"Moore","year":"2003","journal-title":"High Alt Med Biol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1203\/01.PDR.0000069846.64389.DC","article-title":"Intrauterine growth restriction, preeclampsia, and intrauterine mortality at high altitude in Bolivia","volume":"54","author":"Keyes","year":"2003","journal-title":"Pediatr Res"},{"key":"ref37","article-title":"Effects of cold and altitude on vitamin and mineral requirements","volume-title":"Nutritional needs in cold and in high-altitude environments: Applications for military personnel in field operations","author":"Reynolds","year":"1996"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"S101","DOI":"10.1177\/15648265080292S114","article-title":"Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development","volume":"29","author":"Molloy","year":"2008","journal-title":"Food Nutr Bull"},{"key":"ref39","author":"DeWit","year":"2024"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"43","DOI":"10.22206\/cysa.2022.v6i2.pp43-48","article-title":"Incidencia de cardiopat\u00edas cong\u00e9nitas en pacientes ingresados en la unidad de Neonatolog\u00eda del Hospital Infantil Robert Reid Cabral, 2016-2018","volume":"6","author":"Mancebo Garc\u00eda","year":"2022","journal-title":"Ciencia y Salud"},{"key":"ref41","author":"Clemades M\u00e9ndez","year":"2021"},{"key":"ref42","first-page":"33","article-title":"Incidence of congenital heart disease in tertiary care hospital","volume":"6","author":"Shah","year":"2008","journal-title":"Kathmandu Univ Med J (KUMJ)"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"666","DOI":"10.5935\/abc.20180175","article-title":"Mortality for critical congenital heart diseases and associated risk factors in newborns. A cohort study","volume":"111","author":"do Amaral Lopes","year":"2018","journal-title":"Arq Bras Cardiol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1497253\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T05:24:33Z","timestamp":1738128273000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1497253\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":43,"alternative-id":["10.3389\/fpubh.2025.1497253"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1497253","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]},"article-number":"1497253"}}