Transcript Some guidelines from Dr. Nurur Nahar Fatema

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)
CXR
ECG
ECHO
BP in 4 limbs
SPO2
Negative (No murmur)
(Exclude pulmonary, central
cause)
Negative (With murmur)
- CXR
- ECG
- ECHO
- BP in 4 limbs
- SPO2
 B. BABY WITH RESPIRATORY DISTRESS
SPO2
Low
Normal
Hyperoxia test
Positive
Negative
* CXR
* ECG
* ECHO
* Femoral pulse
* BP 4 limbs
C. Baby with feature of shock, Acidosis
Hyperoxia test
Positive
Negative
Duct dependent cyanotic heart disease
TGA, TA, PA
* Radiofemoral delay
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