How to Deal with A Newborn Baby with Congenital Heart Disease?

Brig. Gen. Prof. Nurun Nahar Fatema

Neonatal cardiology is the most important segment of pediatric cardiology.

Why?

1. Baby born with the congenital heart diseases(CHD). So all the congenital problems are there with the baby since
2. CHD is an important cause of mortality and morbidity in
3. Treatment of many such problems are possible only in neonatal
4. Interventions of many such problems are possible only in neonatal
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

How to suspect?

If you observe any of the followings:

1. Presence of
2. Respiratory
3. Unexplained shock/Acidosis.
4. S/S of Heart
5. Presence of

What to Do?

1. Do a hyperoxia test to exclude cyanotic
2. Record SpO2 in all four
3. Record BP in all four
4. Do an ABG if not hyperoxia
5. Do CXR, ECG +/- Echo if

Next Step

If any of the above observation is suspicious than

1. Refer the case to tertiary care center to a pediatric

Interventional Paediatric Cardiologist, Combined Military Hospital, Dhaka, Bangladesh

2. Ensure safe transport of patient by ensuring maintainance of body temperature, nutrition, oxygenation and

Important treatment modalities for newborn with CHD.

1. Medical
   1. Inj Prostin: To maintain patency of the ductus
   2. Inj  Indomethacine        to close haemodynamically significant ductus
   3. Treatment of
   4. Treatment of Heart Failure with
   5. Inj Isoprenaline for bradyarrhythmia
   6. Treatment of PPHN and
   7. Treatment of shock, Acidosis,
2. Transcatheter intervention
   1. Balloon atrial septostomy for creating ASD for mixing of
   2. PDA stenting to keep the ductus patent in duct dependant
   3. Balloon valvoplsty for critical aortic and pulmonary
   4. Balloon angioplasty for coarctation of
   5. Stenting of
   6. Pericardiocentesis for Pericardial
   7. Laser perforation of atretic pulmonary
3. Surgical treatment
   1. Palliative BT shunt, PA
   2. Corrective CoA repair, IAA repair,

Screening of New born

Do screening of following babies of your neonatal unit

1. All downs syndrome,
2. All baby with any other form of congenital
3. Baby of diabetic
4. Baby of SLE
5. All Preterm, IUGR and Low-birth weight
6. Mother with H/O teratogenic drug
7. Mother with H/O TORCH infection in pregnancy

Well Baby Clinic

Check all children for cardiac murmur when they attend Imunization 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. Currently there is an outbreak of Rubella and we are getting lot of babies with CRS. Please convey the message to all.