HOW TO DEAL WITH A NEWBORN BABY WITH CONGENITAL HEART DISEASE ? NURUN NAHAR FATEMA INTERVENTIONAL PEDIATRIC CARDIOLOGIST

Neonatal cardiology is the most important segment of pediatric cardiology .

Why ? 1. Baby born with the congenital heart disease (CHD). So all the congenital problems are there with the baby at birth. 2. CHD is an important cause of mortality and morbidity in newborn. 3. Treatment of many such problems are possible only in neonatal period. 4. Interventions of many such problems are possible only in neonatal period. 5. Most of the patient (almost 100%) with persistent fetal circulation, Persistent pulmonary hypertension of newborn and complex CHD like TGA without shunt, TA,PA , HLHS die in neonatal period.

How to suspect Congenital heart disease? If you observe any of the followings: 1.Presence of cyanosis. 2. Respiratory distress 3. Unexplained shock/ Acidosis 4. S/S of Heart failure. 5. Presence of murmur.

What is the next step? 1.Do a hyperoxia test to exclude cyanotic CHD. 2.Record Spo2 in all four limbs. 3. Record BP in all four limbs. 4.Do an ABG before and after hyperoxia test. 5.Do CXR, ECG +/- Echo if available.

Next Step.. If any of the above observation is suspicious than: 1. Refer the case to tertiary care center to a pediatric cardiologist. 2. Ensure safe transport of patient by ensuring maintenance of body temperature, nutrition, oxygenation and ventilation.

HOW TO DEAL WITH A NEWBORN WITH CONGENITAL HEART DISEASE. A. CYANOTIC BABY Hyperoxia test   Positive (Heart disease) Negative (No murmur) (Exclude pulmonary, central cause) Negative (With murmur) CXR - CXR ECG - ECG ECHO - ECHO BP in 4 limbs - BP in 4 limbs SPO2 - SPO2

B. BABY WITH RESPIRATORY DISTRESS SPO2  Low Normal  Hyperoxia test * CXR * ECG * ECHO Positive Negative * Femoral pulse * BP 4 limbs

C. Baby with feature of shock, Acidosis Hyperoxia test   Positive Negative Duct dependent cyanotic heart disease * Radiofemoral delay TGA, TA, PA Weak or absent femoral pulse * BP gradient > 20 in upper & lower limbs * Coarctation of aorta * Interrupted aortic arch. D. Baby with heart failure CXR ECG ECHO

Important treatment modalities for newborn with CHD. Medical treatment. Trans catheter intervention Surgical treatment

Medical treatment. 1. Inj Prostin : To maintain patency of the ductus arteriosus. 2. Inj Indomethacine to close haemodynamically significant ductus arteriosus. 3. Treatment of SVT 4. Treatment of Heart Failure with Ionotropes 5. Inj Isoprenaline for bradyarrhythmia 6.Treatment of PPHTN and PFC 7. Treatment of shock , Acidosis, Spell

Transcatheter intervention 1. Balloon atrial septostomy for creating ASD for mixing of blood. 3. PDA stenting to keep the ductus patent in duct dependant lesion. 4. Balloon valvoplsty for critical aortic and pulmonary stenosis. 5. Balloon angioplasty for coarctation of aorta 6. Stenting of ASD 7. Pericardiocentesis for huge PE.

Surgical treatment 1. Palliative: BT shunt , PA Banding 2.Corrective: CoA repair , IAA repair, ASO,

Screening of New born Do screening of following babies of your neonatal unit 1. All downs syndrome baby. 2. All baby with any other form of congenital malformations. 3. Baby of diabetic mother. 4. Baby of SLE mother. 5. All Preterm, IUGR and Low-birth weight baby. 6.Mother with H/O teratogenic drug intake. 7.Mother with H/O TORCH infection in pregnancy period.

Well Baby Clinic Check all children for cardiac murmur when they attend Immunization clinic which can be recognized as well baby clinic in our country.

Oxygen Therapy Remember that Oxygen is a drug and do not give o2 without monitoring of surface Sao2. It can cause heart failure in left to right shunt cases from pulmonary vasodilatation , can cause BPD and Retrolental Fibroplasia and permanent blindness.

Message Please Immunize all the young Girl and Woman of reproductive age with MMR vaccine to prevent Congenital Rubella Syndrome (CRS) in the fetus,if not immunized in infancy. Currently there is an outbreak of Rubella and we are getting lot of babies with CRS, Please convey the message to all.

THANK YOU