Colombian technology transforms pediatric cardiology and reduces infant mortality

• Promesa, a revolutionary program in Colombia, allows doctors and families to monitor the health of over 150 children with complex congenital heart diseases through advanced technology and remote tracking.
• Since its implementation in 2021, the program has significantly reduced infant mortality among the patients treated, marking a profound shift in how these conditions are managed in the country, while substantially improving the quality of life for the children and their families.
• As the only program in Colombia offering continuous remote monitoring, Promesa provides specialized medical care from home, minimizing unnecessary hospitalizations and enabling real-time tracking, making it an innovative model with the potential to be replicated in other regions of Latin America.

Bucaramanga, Colombia, October 2024. According to a study published by the National Library of Medicine (NIH), congenital heart diseases (CHD) affect between 0.8% and 1.2% of live births globally. In Latin America, these conditions are among the top ten causes of infant mortality and represent the fifth leading cause of death in children under one year and under five years who do not receive timely treatment. In Colombia, statistics show that 14% of children with CHD do not survive their first month of life, and 30% die before their first birthday.

Among the patients who have faced this complex reality is Guadalupe González Chica, born with pulmonary atresia with intact septum, a severe malformation that prevents blood from flowing properly from the heart to the lungs. Since her diagnosis, she has faced multiple medical challenges; however, at just three years old, she has become a symbol of hope for other families going through similar situations.

María Elizabeth Chica Guerrero, Guadalupe's mother, recalls the most difficult moments of her pregnancy: "From 11 weeks of gestation, the doctors informed me several times that my baby's chances of survival were very low."

Despite the unfavorable prognosis, 15 days after birth, María Elizabeth and her daughter were airlifted from Neiva to Floridablanca to receive specialized care at the Instituto Cardiovascular of the Hospital Internacional de Colombia (HIC). The medical staff informed her that it was possible to intervene in Guadalupe’s condition, opening a new hope for the family.

With the first surgery already performed, María Elizabeth highlights the progress she has seen in her daughter: "Guadalupe has progressed a lot; every day we see her looking more beautiful. We know there is still a long way to go, but we keep our excitement and hope alive to improve her quality of life at every stage we face."

Comprehensive Care from Home

The Promesa program, developed by the HIC, has been crucial in Guadalupe’s recovery, as well as in the care of other children with congenital heart diseases. This initiative allows for managing their health from home, reducing the need for frequent hospitalizations. Additionally, it offers families continuous and specialized follow-up, ensuring that each patient receives the proper care at all stages of treatment.

Guadalupe was one of the first patients to enter the program during its initial phase in 2021. Dr. Javier Mauricio Castro Monsalve, head of the Pediatric Heart Failure and Transplant Program at HIC, explains: "When she arrived at the hospital, we were launching the clinical phase of this project, designed to provide comprehensive support to children with complex congenital heart diseases."

Without timely intervention, the prognosis for many of these patients is unfavorable, with a high risk of death within the first few weeks of life. Promesa has not only changed this reality by providing care from pregnancy to adulthood, but has also overcome economic and geographic barriers that previously made it difficult for families to access the necessary treatment.

“Now the children can remain stable at home, return in better condition for a second surgery if needed, and avoid severe decompensations. Furthermore, we have managed to reduce readmissions and unnecessary hospitalizations, ensuring both medical stability and emotional well-being,” notes Dr. Castro.

Beyond the medical benefits, the program has also enabled children to live fuller lives, and families to regain peace of mind. "The greatest achievement is seeing the children happy in their environment, playing, eating, and enjoying life like any other child. It’s also gratifying to see that the caregivers now feel more prepared to accompany them and resume their daily lives,” says the doctor.

Innovation in pediatric care: Technology and empathy at the service of children’s health

The Promesa program combines technology, continuous care, and empathy to improve the care of these children. The model, with potential for replication in other regions of Latin America, trains primary caregivers on key topics such as heart physiology, warning signs, and proper medication administration, ensuring a timely response to any complications from home.

“Promesa has evolved based on the needs of our patients, which sets us apart from the models in developed countries,” explains Dr. Castro Monsalve. “In those countries, it was initially designed exclusively to treat children with hypoplastic left heart syndrome between the first and second surgeries. Here in Colombia, we identified that our patients need more support, so we extended care beyond the second and third surgeries and included those with other heart conditions, offering a more comprehensive follow-up.”

Among the services offered by Promesa are teaching techniques to measure oxygen saturation, heart rate, and baby weight, along with the necessary guidance to manage medical authorizations and specialized services. The program organizes patient follow-up into five categories according to their specific condition and provides direct support to families to manage hemodynamic decompensations, indicating when to go to the emergency room.

María Elizabeth Chica highlights the positive impact of the program: “Thanks to Promesa and the HIC team, today I can see Guadalupe grow and smile.”

Originally conceived as a research project supported by Minciencias and Universidad Pontificia Bolivariana (UPB), this initiative has provided care to more than 150 patients with various heart conditions over the past three years. Additionally, it is supported by an educational app that offers relevant information on nutrition and child development, providing comprehensive and continuous support for each family. This tool has been key to empowering caregivers, ensuring that children receive the appropriate care at each phase of treatment.