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Management of newborn with cardiac problems Speaker: Prof. Brig Gen Nurun Nahar Fatema Head Of Paediatric Cardiology CMH, Dhaka Cantt. INTRODUCTION Khadiza o5 days old female child got admitted with cyanosis & respiratory distress since


  1. Management of newborn with cardiac problems Speaker: Prof. Brig Gen Nurun Nahar Fatema Head Of Paediatric Cardiology CMH, Dhaka Cantt.

  2. INTRODUCTION Khadiza o5 days old female child got admitted with cyanosis & respiratory distress since birth. With this complaints they first With this complaints they first reported to a private clinic from there she is referred to CMH Dhaka. In CMH dhaka Hyperoxia test in done which indicated for heart disease & urgent ECHO had been done

  3. Corrective surgery Then the patient send to abroad for final corrective surgery with in 1 months of age. in 1 months of age. Arterial switch operation was done on 25 Aug 2017 in Jaypee Hospital, India

  4. Baby born with cardiac problems are increasing alarmingly ………… � Neonatal ICU in every hospitals are trying to incorporate neonatal cardiac care in respective hospitals. hospitals.

  5. INTRODUCTION Expanded availability of prenatal diagnosis and assessment, increased accuracy of genetic analyses and counseling have made it possible to alert families and caregivers to the possibility of a newborn born with cardiovascular compromise. newborn born with cardiovascular compromise. Unfortunately despite the increasing sophistication, precision and availability of methods of detection, only 1% of all complex cardiac malformations in viable fetus are detected before acute clinical presentation.

  6. INTRODUCTION cont… Evaluation of a newborn with real or suspected CHD are not Cardiac performed in Pulse oxymetry / Umbilical venous Chest x-ray Hyperoxia test Echocardiography catheterization, isolation but are arterial blood gas sampling angiography integrated into the overall assessment of the patient, these are:

  7. Background � �������������������������������������������� ����������������������������������������������� ��������������������� ������������������� ������������������������ ������������!������" �� ����#$ �� ����#$ ��

  8. Background � ��������������������������������������%&�'����� ����������������������������������������������� ()��*�+��,����������������������������-��������.� )�������� !��,�����+�������������������&'%�� +�� ������� ����� ������/

  9. Background Table-I: Frequency of congenital heart disease among hospital live birth (2004-2006). Subject Male Female Total Percentage Live birth 3117 2551 5668 100% Neonates with 92 50 142 2.5% congenital heart disease ()��*�+��,����������������������������-��������.�)�������� !��,� ����+�������������������&'%���+�� ������� ����� ������/

  10. Background Table-II: Percentage of positive Echocardiographic findings in suspected newborn and newborn for screening (In CMH ECHO LAB) 2004-2006 (In CMH ECHO LAB) 2004-2006 Subject No (Screening) Percentage (Screening) Total suspected 658 (207) 100% (31.45%) newborn CHD Newborn with 142 (58) 21.58% (8.81%) CHD

  11. Background Table – III Percentage of newborn echo in Lab Aid Cardiac Hospital in Ped lab 2009 Hospital in Ped lab 2009 Parameter No Percentage Total Echo 9065 100% (Pediatric) Newborn Echo 926 11.05

  12. Background Percentage of newborn echo in Lab Aid Cardiac Hospital ( Ped lab) from 2009 to 2017

  13. Statistics of Newborn Catheter Intervention since 1998

  14. Statistics of Pharmacological Intervention since 1998

  15. Awareness created Recently there has been an increasing awareness of the importance of early referral of newborn infants with heart disease to special centers. The ease and safety of transport in new ventilator incubators has encouraged this transfer. Early referral, improvement of diagnostic methods, medical management, catheter intervention and surgical treatment have further improved outcome of congenital heart diseases.

  16. Treatment facilities : Newborn ������������������������������������������������ ������������������������������������������������������� �������������������������������� ���������������������� ���������������������������������������������������������� �������������������������������������������������������� ��������������������������� �

  17. Incidence Sr Types Persentage 01 Newborn 0.8% ( 2.5% in Bangladesh) 02 Still born 3 – 4 % 03 Abortus 10 – 25% 04 Premature infants 2% 05 Newborn with symptomatic 2 – 3% CHD 06 Diagnosis achieved by 1 week 40 – 50% 07 Diagnosis achieved by 1 50 – 60% month

  18. MANIFESTATIONS OF CHD IN NEWBORN Observation � Cyanosis, � Respiratory distress, � Peripheral desaturation, � Behavioral abnormality and less activity

  19. MANIFESTATIONS OF CHD IN NEWBORN Palpation � Thrill � Poor perfusion � Poor perfusion � Hepatomegaly Auscultation � Abnormal heart sounds � Murmurs & bruits �

  20. TRANSPORTATION OF NEWBORN Transportation is necessary to provide: � � Definitive diagnosis Definitive diagnosis � Ongoing medical care � Corrective intervention � Lifesaving intervention � Corrective surgery � Treatment of acute deterioration

  21. Cont… � Baby should arrive at referral centre in as good a condition as possible. � The following complications must be avoided: Hypothermia Hypothermia Acidosis Metabolic disturbances Severe hypoxia � Logistics of transport should be checked properly before transfer

  22. CARDIAC EMERGENCIES: CYANOTIC -CHD Commonest in the first week of life . � Hypo plastic left heart syndrome � Transposition of Great Arteries � Transposition of Great Arteries � Pulmonary atresia or severe pulmonary stenosis � Total anomalous pulmonary venous drainage � Tricuspid Atresia � Ebstein Anomaly

  23. CARDIAC EMERGENCIES: HEART FAILURE Hypoplasia of the left heart. a. Coarctation of Aorta. b. Severe Aortic Stenosis Severe Aortic Stenosis c. c. Persistent Truncus Arteriosus. d. Double Outlet Right Ventricle e. Complete A-V canal defect f. Cortriatiatum. g. Large A-V fistula h.

  24. CADIAC EMERGENCIES: MURMURLESS HEART Cyanotic A cyanotic � � TGA CoA � � TAPVD Cortriatriatum � � HLHS Myocarditis � � � � PA PA Single ventricle Single ventricle � ALCAPA

  25. MURMURLESS OTHER EMERGENCIES Persistent fetal circulation (PFC): � PA Pressure high � Rt to Lt shunt through ASD and PDA � Infant presents with cyanosis, respiratory distress. � H/O Perinatal Asphyxia present. � H/O Perinatal Asphyxia present. � Difficult to diagnose by Echocardiography and often missed by inexperienced Echo cardiographer � Mortality 25-30%if not treated.

  26. MURMURLESS OTHER EMERGENCIES Persistent Pulmonary Hypertension (PPHN): � PA Pressure high � Lt to Rt shunt through ASD and PDA � Infant presents with cyanosis, respiratory distress. � H/O Perinatal Asphyxia may not present. � H/O Perinatal Asphyxia may not present. � Difficult to diagnose by Echocardiography and often missed by inexperienced Echo cardiographer � Mortality 25-30% if not treated.

  27. TRANSIENT MYOCARDIAL ISCHAEMIA � H/O Perinatal Asphyxia present � Myocardial glycogen reduced � Present with cyanosis, respiratory distress, hepatomegaly. distress, hepatomegaly. � Shock in severe case.

  28. DO NOT FORGET � Neonatal Hypocalcaemia (cause of heart failure) � Systemic Arteriovenous fistula � Arrhythmias in newborn: SVT, Complete � Arrhythmias in newborn: SVT, Complete heart block. � Severe anemia, hypoxia, hypoglycemia

  29. PROBLEMS ASSOCIATED WITH HAEMODYNAMICS AND MITABOLIC BALANCE � Hypotension � Desaturation � Brady / Tachycardia � Hypo perfusion � Hypo perfusion � Hypoxia � Acidosis � Hypothermia � Hypoglycemia / Hypocalcaemia � Renal failure � Multi organ failure

  30. HOW TO DIAGNOSE � A. Clinical suspision - Cyanosis - Respiratory distress - Lathergy - Hypoperfusion - Hypoperfusion - Shock � B. Investigation - Hyperoxia test - CXR - ECG - Echo - Blood gas analysis

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