We previously talked about the examination method that health care providers follow to search for diseases and ensure the safety of newborns. In this article, we will talk about the physical findings in the newborn that indicate congenital heart disease.
- Heart problems come in many forms, ranging from mild to severe. We’ll talk about some of them and some guidelines on how to find them.
- Congenital heart diseases have traditionally been divided into two categories: Cyanotic and non-cyanotic disease, The difference between them is due to the percentage of oxygen.
- When oxygen is low enough and the pulse oximeter records a value of less than 85%, the child’s tongue, lips and skin will turn blue.
- NoteImmediately after birth, the newborn is likely to have blueness in the fingers and toes. This is not attributed to a heart defect, but rather is a natural result of the distribution of blood to the organs and is known as “blueness of the extremities,” as the body’s priority at that time is to obtain good blood flow to the heart. The brain, lungs, liver, and kidneys, and the blue color usually disappears after 24 hours.
- The most common types of congenital heart defects:
- Cyanotic heart disease (tetralogy of Fallot – tricuspid atresia – truncus arteriosus – transposition of the great arteries – total anomalous venous return – dangerous pulmonary stenosis – left heart syndrome).
- Non-cyanotic heart disease (ventricular septal defect, atrial septal defect, patent ductus arteriosus, aortic stenosis, less severe pulmonary valve stenosis).
- It is important for the newborn health care provider to suspect that there may be a problem with the newborn’s heart and to refer him to a specialist to more accurately determine the disease and develop a sound treatment plan.
The heart is a complex organ, It consists of muscles, nerves, chambers and valves. But it is essentially a mechanical pump, Its function is to pump blood to the lungs to obtain oxygen. Then it receives the oxygenated blood and sends it to the rest of the body to deliver oxygen along with nutrients, hormones and vitamins to the entire body.
- When there is a lack of oxygen or abnormal pressures or flows, as in the case of congenital heart disease, He has to work harder, The muscles become stretched and fatigued and are unable to perform their function efficiently (heart failure). Since this is the end point of all prominent heart diseases, Therefore, congenital heart defects must be detected and intervened before heart failure occurs.
- Congenital heart disease (CHD) is the most common type of birth defect, affecting 8 out of every 1,000 newborns. Each year, approximately 35,000 children in the United States are diagnosed with coronary heart disease, approximately 25% of which are congenital heart defects that require surgery or other interventions within the child’s first year of life.
- As a result of significant advances in the medical and surgical management of heart disease, it is expected that 85% of children with coronary heart disease will live into adulthood.
- Performing open-heart surgery on children will lead to difficulty and problems with feeding and also difficulty in gaining weight. Therefore, special high-calorie diets are adopted.
- -Also, infants and children who suffer from heart disease have weaker immune systems than a normal child. They can end up in the hospital due to illnesses from which others recover on their own. So many parents take extra precautions to try to keep their children healthy.
- In addition, as the child grows, parents must achieve a balance between allowing their child to live normally and protecting him. So the line between healthy limits and overprotection remains a constant source of concern.
- The information in this article should not be used as a substitute for the healthcare and advice of a patient’s pediatrician.
- There may be variations in the treatment your pediatrician may recommend based on the patient’s situation, the underlying facts, and the individual circumstances of each patient.
Basic guidelines for detecting a congenital heart defect in newborns:
- Initial findings that may suggest the presence of a congenital heart defect include (rapid and irregular heart rate, rapid breathing, decreased skin perfusion and palpation of pulses, presence of audible murmurs, and cyanosis).
- A child with heart disease usually experiences many of the symptoms mentioned together, Each symptom alone cannot confirm the possibility of a heart defect and may indicate other problems.
- The normal heart rate for a newborn is 100-160 beats per minute at rest and increases when crying.
- If the heart rate is more than 160 beats per minute, it can be associated with many things, including dehydration and fever. In addition, it may be a sign that the heart is not working well. Either because it is working hard or is failing, or there may be a problem with the heart’s electrical conduction system.
- low heart rate, Which is less than 100 is also a cause for concern, and we see this condition when the newborn suffers from a lack of oxygen or a problem with the electrical conduction system of the heart.
- The heart beats at a very regular rhythm, and from time to time there are additional beats followed by a pause. These heartbeats are called ectopic heartbeats. This is considered normal during the transition period immediately after birth. It can reach 8 beats every minute in a newborn. These abnormal heartbeats generally disappear during the first days. If it continues longer than that, a cardiologist should be consulted.
- The normal respiratory rate for newborns is (30 – 60) breaths every minute in the resting position.
- Rapid breathing is one of the prominent signs of respiratory distress associated with lung diseases. It can be observed in infants with congenital heart disease, If the newborn does not have enough oxygen in the bloodstream for any reason, The brain will sense this and in turn send a signal to the respiratory system to take more rest and bring in oxygen.
- The difference between tachypnea due to heart and lung causes is that in the case of heart disease, the lungs are usually healthy. At least early in the disease. In the case of lung diseases, the lungs are heavy and rigid, and in order to expand them, a great deal of muscle effort is required. We see this reflected in contractions and increased breathing work.
- – When the heart begins to fail and its work as a pump becomes less efficient, blood flow through the arteries becomes slower. On a physical examination, we can find that this is what happens by pressing on the skin until it turns white. Then we raise our finger and count the time until the skin regains its color at the sternum and regains its color. Skin tone in less than 3 seconds. If it takes longer, we say that the infant suffers from delayed perfusion.
Perfusion: It is the medical term that refers to the flow of blood in tissues. A decreased rate of perfusion is an early sign of decreased blood flow to tissues, and if it continues, blood pressure will decrease, eventually leading to shock.
- Checking the patient’s pulse is a quick and easy way to feel the heart rate and rhythm in addition to blood pressure. In a newborn, it is easier to feel pulses in the humeral and femoral positions.
- The femoral arteries are the main arteries that transport blood to the legs. We can feel the femoral artery pulse, and this must be checked at birth and periodically during the first years of life. If we cannot feel the femoral pulse, we will need further examination procedures to ensure that there is no stenosis.
- Aortic stenosis: This term means that the aorta becomes narrow and blood flow beyond that location becomes compromised.
- Of the 2,500 babies born in the United States each year, approximately 1 has aortic stenosis. If the diagnosis is made correctly and correctly, surgical correction is possible and usually achieves excellent results.
- During the fetal period, there are cardiac shunts that are open, in addition to the fact that lung pressure is high in the fetus. The fetus receives oxygen that is not used by the mother’s systems, and once the baby is born and breathes on its own, Pulmonary pressures will decrease and shunts will close, But it will take hours or even days for that to happen. As a result, There are several heart murmurs that can be heard in the newborn period. There are benign or normal murmurs that reflect active flow, These murmurs occur between the first and second heart sounds. It has an intense bloating quality.
- While listening to the heart, it is important to listen to all four oscillations. The sound of blows sounds different in different places, It may be evidence of a type of congenital heart disease.
- The sound of the murmurs is louder in the pulmonary and tricuspid regions and does not affect the child in negative ways.
- A newborn baby who suffers from benign bloating during birth will be able to feed normally. His heart rate will be normal, with no difficulty breathing, no need for oxygen, and a normal color. With the passage of time and the end of the transitional period, the murmurs will become softer and then disappear.
- In contrast, in the case of pathological murmurs, they tend to become more noticeable over time. Those shunts that were present in the fetus help circulate the blood, and with the end of the transitional phase, symptoms appear in children with heart defects. Murmurs are often associated with cyanosis. By checking the oxygen status using a pulse oximeter, we find that it is low
- Infants may have slow perfusion and rapid breathing rates and will be unlikely to be able to feed normally and well.
Prepared by: Dalal Edriss
- University Of Colorado System
- Heart Public Health Consortium (CHPHC)