Congenital heart disease in neonates: Their clinical profile, diagnosis, and their immediate outcome

Abstract

Background: Congenital heart disease (CHD) occurs in approximately 0.6%–0.8% of live births. Early recognition of CHD is important for appropriate management and decision-making regarding referral. The purpose of this study was to document the common presenting symptoms and signs in the neonates with CHD, definitive diagnosis, and their outcome. Materials and Methods: The study was conducted prospectively in Neonatal Intensive Care Unit, G.B Pant Children Hospital, Department of Pediatrics and Neonatology, GMC Srinagar, from January 2016 to January 2018. Echocardiography screening of all neonates suspected of having CHD was done. Details of all neonates having CHD diagnosed by echocardiography were noted in the prescribed pro forma and their incidence, clinical profile, and outcome were studied. Results: Totally 529 cases of CHD diagnosed by echocardiography in the neonatal period were studied, out of which 280 were male and 259 were female (male:female = 1.12:1). 382 (72.2%) had acyanotic CHD and 147 (27.7%) had cyanotic CHD (CCHD). Among the acyanotic CHD, the most common CHD was ventricular septal defects (n = 170, 32.1%), and among cyanotic group, d-transposition of great arteries was most common (n = 41, 7.75%). Majority of CCHDs were diagnosed in 1st week of life (n = 50, 34.01%) and most of the neonates with acyanotic CHD were diagnosed in the 4th week of life (n = 207, 39.1%). The most common presenting problem of neonates was fast breathing 230 (43.4%) followed by feeding difficulty 110 (20.77%), cyanosis 91 (17.2%), shock manifested as decreased urine output (n = 43, 8.1%), 43 neonates (8.1%) had cyanosis along with fast breathing, and 32 neonates (6.04%) presented with murmur only. Sixty neonates (40.8%) with CCHD expired within the neonatal period. Conclusion: Neonates with CHD have a unique presentation and they carry a poor outcome unless diagnosed early and managed appropriately. Infants presenting with multiple anomalies should be screened for any underlying structural heart disease. High index of suspicion is very important as many neonates with CHD are asymptomatic initially.