Right care for little ones

Congenital heart defects (CHD) impacts eight in every 1,000 children born in India. According to statistics, approximately 1.5 to 1.8 lakh babies are born with CHD. The common cause for the disorder lies in the defects in a child's heart development. It is not always

possible to determine the cause of congenital heart diseases, but most tend to be genetic.

CHD is also not entirely preventable, as most cases are detected in mothers with no risk factors. However, certain environmental and genetic risk factors like diabetes, medications, alcohol consumption and smoking also contribute to this condition in kids.

A congenital defect in a baby is normally detected within 22 days after conception during ultrasound scanning. Any abnormal heartbeat can be detected by the doctor at this stage. The anomalies could be confirmed with advanced tests like an MRI scan.

In some cases, the symptoms of a congenital heart defects may not appear until birth. Here are few of the symptoms detected in babies who suffer from congenital defects:

Low birth weight

Bluish lips, fingers and toes

Breathlessness

Feeding difficulty

These symptoms can vary with age since it is a condition that develops as the child grows. In some cases, the symptoms don't appear until many years after birth, and these signs include abnormal heart rhythm, dizziness, fainting, swelling of limbs, etc.

CHD is a result of an early developmental problem in the heart's structure, which restricts the flow of blood through the heart and affects the breathing. The medical world is still researching on the right cause for this.

The treatment for CHD is decided after studying the severity and type of disorder. Some babies have mild heart defects that heal on their own with time, while severe defects could require extensive treatment including surgery. In such cases, the treatment may include the following:

Medication: Medicines can increase the efficiency of the heart and some can also be used to prevent formation of blood clots or simply to control an irregular heartbeat.

Catheter procedures: Catheterisation techniques could repair certain congenital heart defects without surgically opening the chest and heart. This is performed by inserting a thin tube into a vein in the leg and guiding it up to the heart. Once the catheter is in the correct position, doctors use small tools threaded through the catheter to correct the defect.

Implantable heart devices: Certain complications associated with CHD can be prevented with the use of pacemakers and implantable cardioverter defibrillators. A pacemaker can regulate an abnormal heart rate and ICD may correct irregular heartbeats.

Open heart surgery: A surgeon may perform open heart surgery to close holes in the heart, repair heart valves or widen blood vessels.

Heart transplant: In the most complex cases, the baby's heart will be replaced by a healthy heart from a donor. Heart transplantation is chosen as the last option, only if all the other line of treatments don't work.

Early diagnosis is extremely important, as children with high-risk CHD can die if they are not diagnosed early enough and given the right care. Even if they survive, chances are they will have uncorrected heart defects in adulthood which will require medical attention later. An early diagnosis, followed by initiation of appropriate treatment intervention should be the most effective solution to keep congenital disorders at bay.

Newborn screening is therefore, the best way to ensure our future generation grows up with healthy hearts. Regular clinical examination at birth and each subsequent visits for congenital heart diseases are done by paediatricians. Some of the tests at birth, such as saturation monitor, blood pressure and CXR are done if there is any heart murmur. If there is significant heart murmur with breathlessness or cyanosis, then baby should be evaluated by a paediatric cardiologist for significant congenital heart defects.

(The author is a senior consultant
Neonatologist and Paediatric Intensivist at Apollo Cradle)