Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP107

Invited Speakers

Early detection of critical congenital heart disease in neonates: a practical approach for primarycare physician

Mulyadi M Djer Department of Child Health Medical Faculty, Universitas IndonesiaJakarta

Criticalcongenital heart disease (CCHD) defined as congenital heart disease (CHD) requiring surgery or catheter-based intervention in the first year of life. Prevalence of CHD at birth ranges from 8 to 10 per 1000 live births. CCHD occurs in approximately 25 percent of those with CHD..Although many newborns with CCHD are symptomatic and identified soon after birth, others are not diagnosed until after discharge from the birth hospitalization. The risk of morbidity and mortality increases when there is a delay in diagnosis and timely referral to a tertiary center in treating those patients. CCHD includes ductal-dependent and cyanotic lesions CHD that are may not require surgery in the neonatal period but still require intervention in the first year of life. Early detection of CCHD help us to provide a prompt treatment. Early detection include the clinical suspicion of a risk factor for CHD by clinicians so that the referral for fetal echocardiography can be done. Prenatal detection has become a significant contributor to early identification of CCHD. A recent meta-analysis has shown that newborns with a prenatal diagnosis of CCHD were significantly less likely to die before planned cardiac surgery than those with a comparable postnatal diagnosis. Even with fetal echocardiograms, which are not available universally, the diagnosis of CCHD during pregnancy is difficult. A thorough physical examination should be performed with attention to findings suggestive signs of CHD, including abnormal precordial activity, abnormal heart sounds, pathologic murmurs, hepatomegaly, diminished or absent lower extremity pulses, abnormal four extremity blood pressure, shock, cyanosis, and respiratory symptoms. A pulse oximeter can help the nursery clinicians identify babies who have oxygen saturation levels below 95% (≥95% is considered normal). Pulse oximetry sensitivity in detecting CCHD has been demonstrated to be high (76.5%) with a specificity up to 99% with a very low false-positive rate, making it a strong test. Chest radiograph may be helpful to evaluate cardiomegaly, dextrocardia, or an abnormal cardiac silhouette. Echocardiography provides a definitive diagnosis of CHD with information on cardiac anatomy and function. Echocardiography should be performed in consultation with a pediatric cardiologist if any of those abnormalities are present. Urgent consultation/referral to a pediatric cardiologist should be made when CCHD is suspected in symptomatic neonates. Initial management begins with general care that includes cardiorespiratory support and monitoring to ensure sufficient tissue perfusion and oxygenation. Infants with ductal-dependent lesions are at increased risk for death and significant morbidity unless interventions are initiated to maintain patency of the ductus arteriosus, ensure adequate mixing of deoxygenated and oxygenated blood, or relieve obstructed blood flow. Prostaglandin should be administered to maintain ductus arteriosus soon after diagnosis of duct-dependent lesions confirmed.

Keywords: congenital heart disease, critical, early detection, prompt treatment, prostaglandin