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Open Journal of Cardiology & Heart Diseases
Easy Steps of Management of Neonates with Congenital Heart Disease (CHD)
Nurun Nahar Fatema*
Congenital and Structural Interventionist, Combined Military Hospital, India
*Corresponding author: Nurun Nahar Fatema, Congenital and Structural Interventionist, Combined Military Hospital, Bangladesh
Submission: November 11, 2022;Published: January 11, 2023
ISSN 2578-0204Volume4 Issue1
Neonatal Cardiology is the Most Important Segment of Pediatric Cardiology for Many Reasons as Follows
a. Baby born with the Congenital Heart Diseases (CHD). So, all the congenital heart
problems can be diagnosed in neonatal period by a thorough neonatal examination.
b. CHD is an important cause of mortality and morbidity in newborn so early detection
is mandatory.
c. Treatment of many such severe problems are possible in neonatal period to save the
life of newborn.
d. Transcatheter interventions and surgeries of many such problems are available in
neonatal period.
e. Most of the patient with persistent fetal circulation, persistent pulmonary
hypertension of newborn and complex CHD like TGA without shunt, tricuspid atresia,
pulmonary atresia, Hypoplastic Left Heart Syndrome {HLHS) die in neonatal period.
f. If fetal echocardiography predicts critical heart disease, then baby should be
delivered in a center with facilities for immediate management.
g. A team composed of neonatologist, pediatric cardiologist, pediatric cardiac surgeons,
intensivist, obstetrician is necessary to deal with such critical cases.
Early Suspicion can be Possible from Following Observations
Neonatal Cardiology is the Most Important Segment of Pediatric Cardiology for Many Reasons as Follows
a. Presence of cyanosis.
b. Respiratory distress.
c. Unexplained shock/Acidosis.
d. signs of Heart failure.
e. Presence of murmur.
f. Feeding difficulty with suck pause suck cycle.
Initial work up for a suspected case of congenital heart disease
a. Head to toe thorough clinical examination to exclude other anomalies or association
with syndromes
b. Hyperoxia test should be done to exclude cyanotic congenital heart disease.
c. SpO2 in all four limbs should be recorded to check any differential cyanosis.
d. Blood pressure in all four limbs should be recorded to check any significant
differences.
e. Arterial blood gas analysis for sick babies to check acidosis
or any metabolic derangement.
f. Chest X-ray, electrocardiography and bedside
echocardiography should be performed. echocardiography will
provide accurate anatomical diagnosis.
Do’s after suspicion or confirmatory diagnosis
a. Refer the case to tertiary care center to a pediatric
cardiologist if nothing can be done other than preliminary work
up.
b. Ensure safe transport of patient by ensuring maintenance
of body temperature, nutrition, oxygenation and ventilation.
Important Treatment Modalities for Newborn with CHD
Neonatal Cardiology is the Most Important Segment of Pediatric Cardiology for Many Reasons as Follows
Some patients are cured after medical management but some of them need advanced catheter intervention or surgical intervention. Following are the summaries of options currently available.
Medical treatment
a) Injection Prostaglandin E1: To maintain patency of the
ductus arteriosus in duct dependent CHD like pulmonary
atresia, critical coarctation of aorta, critical pulmonary
stenosis, interrupted aortic arch, Hypoplastic left or right heart
syndrome etc.
b) Injection Indomethacin , Paracetamol, Ibuprofen to close
hemodynamically significant ductus arteriosus.
c) Treatment of Supra ventricular tachycardia which may
lead to dilated cardiomyopathy without treatment.
d) Treatment of Heart Failure for any other reasons.
e) Injection Isoprenaline for bradyarrhythmia.
f) Treatment of Persistent Pulmonary Hypertension (PPHN)
and Persistent Fetal Circulation ( PFC).
g) Treatment of shock, Acidosis, Spell.
h) Stabilization of critically ill neonates for further
interventions and surgeries.
i) Nutritional management to gain body weight.n and the absence of other
abnormalities to explain symptoms.
Transcatheter intervention
a) Balloon atrial septostomy for creating reasonable atrial
septal defect for mixing of blood in parallel circulation like
transposition of great arteries.
b) Patent Ductus Arteriosus {PDA} stenting to keep the
ductus patent in duct dependent lesions.
c) Balloon valvuloplasty for critical aortic and pulmonary
stenosis.
d) Balloon angioplasty for critical coarctation of aorta.
e) Stenting of atrial septal defect for long lasting palliation.
f) Pericardiocentesis for Pericardial effusion.
g) Laser perforation or stiff wire perforation of atretic
pulmonary valve.
Surgical treatment
a) Palliative surgeries like Blalock Taussig Thomas shunt,
Pulmonary artery Banding.
b) Corrective surgeries like Coarctation repair, Interrupted
aortic arch repair, Arterial switch operation, PDA ligation,
Norwood first stage etc.
Screening of New born
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