Prevalence Of Congenital Heart Disease Research Articles

Assessment of the prevalence of congenital heart disease in children with pneumonia in tertiary care hospital: A cross-sectional study

Background and objectivesPneumonia is the most common cause of death in children under five years of age. Epidemiological factors and the disease burden differ in developing and industrialized countries. The present study is a cross sectional observational study, carried out from August 2018 to August 2020 in Hindu Rao Hospital, to assess the prevalence of congenital heart disease (CHD) in patients with pneumonia in children up to 5 years. The main objectives of the study were to study the prevalence of congestive cardiac failure (CCF) in pneumonia with and without congenital heart disease. Material and methodsPatients under 5 years of age, presenting with pneumonia during August 2018 to July 2020 were enrolled for study. The bio-data of each patient was documented each patient was clinically evaluated thoroughly and findings noted. Pneumonia was diagnosed on typical history, physical findings, blood investigations and chest radiographic finding of pneumonia infiltrates in either one or both lung fields. All the cases of pneumonia underwent transthoracic 2 Dimensional (2D) and Doppler echocardiography, done by the cardiologist. Any congenital heart disease so found was noted. The type and size of the defects was documented. The ventricular septal defects were classified based on the site and size. The size of the patient ductus arteriosus was also determined. These measurements were taken to evaluate the impact of defect size on pneumonia. CCF was diagnosed when the patient fulfilled the clinical diagnostic criteria of heart failure. All the cases of pneumonia underwent transthoracic 2 Dimensional (2D) and Doppler echocardiography for diagnosis of any congenital heart disease. ResultsMean age of the children with pneumonia was 9.94 months with 77.5% of the cases below 1 year of age. Male predominance was seen with 56.3% males to 43.8% females. Prevalence of congenital heart disease among cases of pneumonia was 12.5% while that of congestive heart failure was 27.5%. Most common CHD observed was VSD (14 cases; 8.8%) followed by PDA, ASD and TGA (4; 2.5% and 3; 1.9% and 1; 0.6% cases respectively). A significant association was observed between presence of congenital heart disease and development of CCF. ConclusionOur study demonstrates that most patients with pneumonia or recurrent pneumonia are likely to have an underlying illness at the time of pneumonia. Recurrent ALRTI often occurred in children with history of congenital heart diseases (CHD) and is also associated with Congestive Cardiac Failure. Children with CHD are more vulnerable to recurrent respiratory tract infection.

Birth prevalence of congenital heart disease among newborns in a tertiary hospital in Benin City, Nigeria.

Congenital heart disease (CHD) is an important cause of childhood morbidity. The birth prevalence and distribution of CHD among neonates in a tertiary hospital in Nigeria was determined. This descriptive, cross-sectional study involved consecutive neonates in the neonatal and postnatal wards of the hospital. Bedside echocardiography was conducted on all neonates. Data entry and analysis was done with IBM-SPSS version 20.0. A total of 2 849 neonates were recruited, consisting of 1 482 (52.0%) males. Forty-one neonates had CHD, giving a birth prevalence of 14.4/1 000 live births. Of the 41 with CHD, 21 (51.2%) were male. Thirty-six (87.8%) neonates had acyanotic CHD, of which the commonest was isolated ventricular septal defect [11 (26.8%)]. Transposition of the great arteries [3 (7.3%)] was the commonest cyanotic CHD. The birth prevalence of 14.4/1 000 live births in this study is high and buttresses the need for strengthening existing cardiac services in Nigeria.

To Determine the Frequency of Congenital Heart Disease in Infants of Diabetic Mothers

Aim: To determine the frequency of Congenital Heart Disease in infants of diabetic mother. Methodology: Cross sectional (Descriptive) study conducted in the Department of Pediatrics Special Care Baby Unit (SCBU) Khyber Teaching Hospital Peshawar from 15-04-2015 to 15-10-2015. The sample size was150 patients, using 52.5% incidence of CHD in IDM and 95% confidence interval with 8% margin of error under WHO software Results: This study was carried out on 150 patients at the Department of Pediatrics, Khyber Teaching Hospital Peshawar. CHD was detected in 79 (52.7%) patients while in 71 (47.33%) patients, CHD was not detected. Conclusion: Our study concluded moderate prevalence of Congenital Heart Disease in infants born to diabetic mothers. Keywords: Diabetes mellitus, Pregnancy, Newborn, Heart defects

Relationship of ventricular assist device support duration with pediatric heart transplant outcomes

There is wide variability in the timing of heart transplant (HTx) after pediatric VAD implant. While some centers wait months before listing for HTx, others accept donor heart offers within days of VAD surgery. We sought to determine if HTx within 30 days versus ≥ 30 after VAD impacts post-HTx outcomes. Children on VAD pre-HTx were extracted from the Pediatric Heart Transplant Study database. The primary endpoints were post-HTx length of hospital stay (LOS) and one-year survival. Confounding was addressed by propensity score weighting using inverse probability of treatment. Propensity scores were calculated based on age, blood type, primary cardiac diagnosis, decade, VAD type, and allosensitization status. A total of 1064 children underwent VAD prior to HTx between 2000 to 2018. Most underwent HTx ≥ 30 days post-VAD (70%). Infants made up 22% of both groups. Patients ≥ 12 years old were 42% of the < 30 days group and children 1 to 11 years comprised 47% of the ≥ 30 days group (p < 0.001). There was no difference in the prevalence of congenital heart disease vs. cardiomyopathy (p=0.8) or high allosensitization status (p=0.9) between groups. Post-HTx LOS was similar between groups (p=0.11). One-year survival was lower in the < 30 days group (adjusted mortality HR 1.76, 95% CI 1.11-2.78, p=0.016). A longer duration of VAD support prior to HTx is associated with a one-year survival benefit in children, although questions of patient complexity, post-VAD complications and the impact on causality remain. Additional studies using linked databases to understand these factors will be needed to fully assess the optimal timing for post-VAD HTx.

First descriptive study of congenital heart diseases in French Guiana showing complex epidemiological trends compared to mainland France

Basics French Guiana is an overseas department with diverse population composition. Despite its integration in a European model, there are social issues and high infant mortality, with unknown congenital Heart Disease (CHD) prevalence. Fetal screening, terminations of pregnancy (TOPFA), prevalence, associated chromosomal or genetics anomalies (CGA) and infant mortality of all CHD diagnosed in French Guiana are compared to published data from greater Paris (EPICARD population study, France). Five-year retrospective study including all patients with CHD born in French Guiana from January 2012 to December 2016, as well as CHD diagnosed during pregnancy over the same period. The last cases included were those in the 2016 birth cohort who were diagnosed in 2017. Over 33,796 births [32,975 live births (LB)] during the study period, a total of 231 CHD (56 fetuses), with 18.6% of CGA, were diagnosed including 215 LB (TOPFA rate: 6.5%). The total and the LB prevalence of CHD were 68.4 [95% confidence interval (CI): 67.9–68.8], and 65.2 [95% CI: 64.7–65.7] per 10,000. Having excluded CGA and isolated ventricular septal defects (VSD), the LB prevalence of CHD appeared similar in both regions, while the total prevalence (8/10,000 births, P = 0.03) and LB prevalence (3.9/10,000 LB, P < 0.002) of univentricular hearts were higher. The total infant mortality associated with CHDs in French Guiana is 9.4/10,000 LB, and represents twice the one observed in greater Paris (P = 0.0005). Such difference appears only related (P = 0.0008) to the higher prevalence of univentricular hearts. This study demonstrated for the first time a higher prevalence of univentricular hearts in French Guiana which represents the main current cardiac cause of infant mortality. This act as a significant marker of the global burden of complex CHD in this region Furthers studies are required to extend such findings to surrounding countries of South America.

The association between the congenital heart diseases and congenital anomalies of the kidney and the urinary tract in nonsyndromic children.

Several congenital heart diseases (CHD) are present in children with congenital anomalies of the kidney and the urinary tract (CAKUT) in syndromic or nonsyndromic patterns. The purpose of this study was to identify nonsyndromic children with CAKUT who required echocardiographic evaluation and to find the prevalence of CHD in these patients. Retrospective chart review of nonsyndromic patients with CAKUT between 2012 and 2018 was conducted. Types of congenital anomalies of the kidney and urinary tract and echocardiogram reports of the patients, age, gender, prematurity, prenatal diagnosis of CAKUT, and family history were noted. Among 806 children with CAKUT, 135 patients underwent transthoracic echocardiographic evaluation and CHD was detected in 91 (11.2%). The most common type of CHD was secundum type atrial septal defect that was found in 73 (80.2%) patients. On the other hand, the most frequent types of congenital anomalies of the kidney and the urinary tract were isolated hydronephrosis and primary vesicoureteral reflux (61.4% and 12.8%, respectively). Our results showed that 75.8% of the patients with congenital heart diseases had isolated hydronephrosis. Finally, only 18 (2.2%) cases out of 806 patients that were evaluated via transthoracic echocardiography due to the clinical findings and family history had a CHD that required close (<6months) follow-up. Congenital heart diseases that required close follow-up are rarely observed in nonsyndromic patients with CAKUT. Therefore, we suggest echocardiography should be performed in cases of clinical suspicion and family history rather than routinely in this patient group.

Detection and Treatment of Asymptomatic Patients With Congenital Heart Defects in China and Cambodia: Data From an International Screening and Intervention Project

Background: A considerable amount of children and adolescents suffering from asymptomatic congenital heart disease (CHD) were left in community, due to poor health-related resources and consciousness, particularly in low- and middle- income countries. Thus, we aimed to determine the prevalence of asymptomatic CHD in China and Cambodia, as well as to evaluate the gaps in patients' growth status and the effects of the treatment. Methods: In this study, we sampled kindergartens and schools from 8 provinces in China and 5 provinces in Cambodia. In children and adolescents aged 3-18 years, physical signs and heart sounds were examined, then further echocardiography were conducted to detect the CHD that needs treatment. After treatment, patients were followed up for 1 year to assess the gaps in their height and weight to the standard line. Findings: In the 3 068 075 participants screened (3 015 470 in China and 52 605 in Cambodia), 3891 patients with asymptomatic CHD in need of treatment [0·12%, 95% confidence interval (CI) 0·12%-0·13%] were identified. The prevalence of asymptomatic CHD were slightly lower in China than in Cambodia (0·12% vs. 0·16%, p=0·017). Among the 64 screening sites, the county (district) level prevalence of asymptomatic CHD ranged from 0·02% to 0·88%, which were negatively associated with local per capital GDP (p=0·028), but not significantly related with the local average altitude (p>0·05). Among 3310 treated CHD patients, the height was lower than the standard level at their age -2·23% (95% CI: -2·54%~-1·93%, while the weight gap was -6·41% (95% CI: -7·17%~-5·65%), which have been broadening with age of diagnosis. One year after the treatment, the relative gap in height had persisted, and the relative gap in weight had narrowed by 5·68% (95% CI: 4·27%~7·09%), with the “catching-up” steps bigger in patients who were younger at the treatment. The patterns were consistent between the Chinese and Cambodian patients. Interpretation: Asymptomatic CHD still causes notable public health issue in developing countries. Through timely detection and treatment, the potential burden of children and adolescents could be substantially mitigated. Funding Information: This project was supported by the National Key Research and Development Program of China (grant No. 2018YFC1315501), Yunnan Provincial Clinical Research Center Project (Grant No. FZX2019-06-01) and “Love Heart Journey” project. Declaration of Interests: The authors declared no relevant conflict of interest. Ethics Approval Statement: The ethics committee at the Fuwai Yunnan Cardiovascular Hospital approved this project. All patients who received treatment and were followed have provided written informed consent.

Cardiac changes in infants of diabetic mothers.

Diabetes mellitus (DM) is a systemic chronic metabolic disorder characterized by increased insulin resistance and/or β- cell defects. It affects all ages from the foetal life, neonates, childhood to late adulthood. Gestational diabetes is a critical risk factor for congenital heart diseases (CHDs). Moreover, the risk increases with low maternal education, high body mass index at conception, undiagnosed pre-gestational diabetes, inadequate antenatal care, improper diabetes control, and maternal smoking during pregnancy. Maternal DM significantly affects the foetal heart and foetal–placental circulation in both structure and function. Cardiac defects, myocardial hypertrophy are three times more prevalent in infants of diabetic mothers (IDMs). Antenatal evaluation of the cardiac function and structures can be performed with foetal electrocardiography and echocardiography. Postnatal cardiac evaluation can be performed with natal and postnatal electrocardiography and echocardiography, detection of early atherosclerotic changes by measuring aortic intima-media thickness, and retinal vascular changes by retinal photography. Ameliorating the effects of diabetes during pregnancy on the offspring depends mainly on pregestational and gestational diabetes prevention. However, other measures to reduce the risk, such as using medications, nutritional supplements, or probiotics, still need more research. This review discusses the mechanism of foetal sequels and the risk factors that increase the prevalence of CHDs in gestational DM, the various cardiac outcomes of gestational DM on the foetus and offspring, cardiac evaluation of foetuses and IDMs, and how to alleviate the consequences of gestational DM on the offspring.

Congenital heart disease with neonatal revelation in Tunisia: Epidemiological, clinical and evolutionary aspects

Congenital heart diseases include all heart and vascular malformations; they represent around third of congenital malformations and constitute an important public health issue in Tunisia. The aim of this study is to describe the epidemiological and clinical profile of these malformations and to emphasize on the results encountered through the disease treatment. We propose a retrospective study of 165 congenital heart disease observations collected in the neonatology department of the maternity and neonatology center of Tunis over a period of 2 years from January 2018 to December 2019. The hospital prevalence of congenital heart disease was equal to 3.5%. The sex ratio was equal to 1.11 (52.7% male, 47.2% female). Inbreeding was found in 10.9% of patients. The average maternal age was equal to 33 years; the follow-up of the pregnancy was noted in 60.2% of mothers. Chronic diseases were found in 13.3% (type 1 diabetes 6%); 61.2% of heart diseases were diagnosed in antenatal care. Respiratory distress was the most common symptom (86.6%). Hypotrophy was objectified in 11.5% of newborns however the rate of association of heart murmur and congenital heart disease was 45.4%. Among the patients, 28.4% had associated congenital malformations. Non-cyanogenic congenital heart disease represented 63.3%, however, it represented 36.3% for the cyanogenic ones. Among the patients, 67.6% received medical treatment, 12.7% benefited from surgery or interventional surgery and 86.7% of them received treatment in an intensive care setting. The mortality rate was 64.8%. Congenital heart disease is still shown a significant rate of mortality and morbidity. Improving the prognosis is based on prenatal screening in women at risk in order to be able to develop genetic counselling and to practice a therapeutic termination of pregnancy when it is necessary.

The Impact of Maternal Age on the Neonatal Electrocardiogram

Background: Previous studies have suggested an increased prevalence of congenital heart disease among children born to women aged ≥35 years. In recent decades, the mother’s age at childbirth has increased dramatically in industrialized countries. It has not been investigated if increasing maternal age affects the neonatal cardiac electrical system. Methods: The Copenhagen Baby Heart Study is a prospective general population study that performed cardiac evaluation in newborns. Electrocardiograms were analysed with a computerized algorithm. Echocardiograms were obtained using a standardised protocol. Findings: We included 16,518 newborns with normal echocardiograms (median age at examination 11 days; range 0-30 days; 52% boys). Median maternal age at delivery was 31 years; 790 newborns were born to mothers aged between 16-24 years, 11,403 between 25-34 years, 4,279 between 35-44 years, and 46 newborns had mothers aged between 45-54 years. The QRS axis and maximum R-wave amplitude in V1 (R-V1) differed across the four maternal age groups (both p 0.05). Interpretation: We observed a significant association between maternal age and the neonatal QRS axis and R-V1. However, the absolute differences were relatively small and maternal age is unlikely to have a clinical significant effect on the neonatal cardiac electrical system. Funding: The Danish Heart Foundation, The Danish Children Heart Foundation, Snedkermester Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Regional Ethics Committee (H-16001518) and the Danish Data Protection Agency (Isuite 04546, HGH-2016-53)

Pattern of congenital heart diseases among children attending a pediatric cardiology OPD of a tertiary level hospital in West Bengal, India: a retrospective study

Background: Congenital heart disease (CHD) is one of the most common congenital defects worldwide. The prevalence of CHD is low in India mostly due to under detection. The knowledge regarding socio-demographic factors, other congenital anomalies/syndromes and social impacts associated with CHDs in India is grossly lacking.Methods: This was a retrospective study. Details of all diagnosed pediatric (age 0-14 years) cases of CHD were recorded by a single cardiologist from the year 2013 to 2020. Duplicate entries were removed and CHDs were classified according to Q20-Q28 of tenth revision of international classification of diseases (ICD). For description purposes, the CHDs were divided into 10 sub-groups.Results: Total 9247 cases of CHDs were recorded during the study period. Ventricular septal defect was the most commonly identified CHD (32.1%). Most cases were acyanotic (69.8%) and presented first time at age of more than two years. Almost 1.5% cases were associated with other non-cardiac congenital defect or syndrome. In 1.0% of cases either mother or the child faced social or family problem due to the disease.Conclusions: CHD is an emerging public health problem. It is associated with other congenital anomalies/syndrome. Mandatory screening for birth defects needs to be initiated at all birth facilities. At birth counseling of the parents need to be implemented due to the associated social issues.

The Mathematical Limitations of Fetal Echocardiography as a Screening Tool in the Setting of a Normal Second-Trimester Ultrasound

BackgroundThe effectiveness of screening strategies targeting pregnancies at higher risk of congenital heart disease (CHD) is reduced by the low prevalence of severe CHD, the increase in CHD detection rates by second-trimester ultrasound (U/S), and the high proportion of severe CHD in low-risk pregnancies. We aimed to determine situations in which additional screening by fetal echocardiography (FE) would result in a significant increase in sensitivity and a sizable decrease in the false-negative rate of detection of severe CHD. MethodsWe simulated the change in the numbers of detected severe CHD cases when FE is offered to women with a normal second-trimester U/S who have a higher risk of bearing a child with CHD, compared to U/S alone. The primary outcome was the increase in sensitivity. Secondary outcomes were the number needed to screen and the reduction in the rate of missed cases. ResultsFor an U/S sensitivity of 60%, the addition of FE in pregnancies at high risk of CHD (risk ratio 3.5; range: 2 to 5) increased sensitivity by 2.4 percentage points (1.1 to 7.9). The number needed to screen to detect one additional case of severe CHD was 436 (156 to 952). The rate of additional severe CHD cases detected by FE was 4 per 100,000 pregnancies (2 to 32). ConclusionsThe addition of FE to U/S for severe CHD prenatal screening in pregnancies at high risk of CHD yielded marginal benefits in terms of increased sensitivity and decreased rates of false negatives, at the expense of significant resource utilization.

Prevention and Early Detection of Congenital Heart Defects. Where do we stand.

Introduction: Since the origin of Medicine in 4th BC. Century research has taught us that learning and practicing preventive medicine is properly the best method to prevent disease from happening in the first place. Preventive health care must be planned and executed ahead of time, even when illness/ disease, is absent, especially for those that are common and fаtal. Among neonates and infants, congenital heart disease (CHD) is responsible for the largest proportion of mortality caused by birth defects. Actual numbers of patients and mortality resulting from CHD reportedly is increasing. In the developed world the treatment of CHD has escalating costs for health care systems and private covered patients, while in low-income countries it is not always available. Prevention is urgently needed to tackle the increasing needs.&#x0D; Aim: To present the current practice in preventing/early detecting CHD and justify why pulse oximetry is the best available, early detecting postnatal screening test we currently have.&#x0D; Methods: The existing in use preventing/early detecting methods for avoiding or early diagnosing CHD are: 1. Eliminate the maternal risk factors by obtaining a good level of health and medical surveillance during pregnancy. 2. Avoiding teratogenic agents, 3. Detecting risk factors from Family History, 4. Delivering a balanced Nutrition during Pregnancy 5. Obtaining at least an experienced 4-chamber view and outflow tracts imaging during the 20-weeks anomaly scan. 6. Fetal Echocardiography when indicated 7. Postnatal evaluation by experienced Pediatricians. 8. Pulse Oximetry, screening test after 72 hours post-delivery in term babies. 9. Hyperoxia test when indicated.&#x0D; Conclusion: Although CHD’s are the most common, high morbidity and mortality, congenital malformations, we still lack a single, easy to apply, non-invasive and low-cost screening test, for early detection. The current preventive methods must be combined to counterbalance the CHD prevalence. Meanwhile, they are costly and partially accessible. The most advantageous method for minimizing CHD deaths worldwide seems to be currently, pulse oximetry combined with clinical assessment.&#x0D; Original publication: Petropoulos AC. Prevention and Early Detection of Congenital Heart Defects. Where do we Stand. J Cardiol 2018, 2(1): 000111.

Remote magnetic navigation for heart rhythm disturbances treatment in patients after surgical correction of congenital heart disease

The prevalence of congenital heart diseases is nine persons per 1000. Sometimes, congenital heart disease needs surgical correction. The long-term postoperative period is often associated with complex heart rhythm disturbances like ectopic or re-entry tachycardia. These cases, in combination with difficult anatomy, results in challenges during interventional treatment. Catheter ablation has been demonstrated as safe and effective in different types of arrhythmia treatments in such patients, including paediatric cohorts. Despite these facts, several important problems regarding using current technologies are still unresolved. Remote magnetic navigation showed good results regarding localisation of arrhythmogenic zones during treatment of complex heart rhythm disturbances. The objective of the present article is to review recently published data in this area and experience of Meshalkin National Medical Research Center in heart rhythm disturbances treatment using remote magnetic navigation in patients after surgical correction of congenital heart disease. Received 28 September 2020. Revised 25 December 2020 г. Accepted 30 December 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: A.B. Romanov, A.M. ChernyavskiyDrafting the article: V.V. Beloborodov, А.V. Ponomarenko, E.А. MorzhanaevCritical revision of the article: A.B. Romanov, А.V. Ponomarenko, I.L. Mikheenko, E.А. Morzhanaev, A.G. Filippenko, A.M. ChernyavskiyFinal approval of the version to be published: V.V. Beloborodov, N.А. Yelemessov, А.V. Ponomarenko, E.А. Morzhanaev, A.G. Filippenko, I.L. Mikheenko, A.M. Chernyavskiy, A.B. Romanov

Congenital Heart Disease and Myelomeningocele in the Newborn: Prevalence and Mortality.

Myelomeningocele (MMC) and congenital heart disease (CHD) are independent risk factors for increased morbidity and mortality in the newborn period and each can require significant operations shortly after birth. Few studies have examined the impact of these combined lesions. We sought to examine the incidence of CHD in patients with MMC, and to evaluate length of stay (LOS), hospital charges, and mortality. Using the Texas Inpatient Public Use Data File, ~ 6.9 million newborn records between 1/1999 and 12/2016 were examined. Hospitalizations were classified as MMC without CHD (n = 3054), CHD without MMC (n = 72,266), and MMC with CHD (n = 171). The birth prevalence of CHD with MMC was 0.3/10,000 live hospital births, with 5% of patients with MMC having CHD, and 0.2% of those with CHD having MMC. There was increased LOS in patients with both MMC and CHD (median 15days, IQR 5-31), compared to CHD without MMC (median 6days, IQR 2-20) and MMC without CHD (median 8days, IQR 1-14) and higher total hospital charges (median $95,007, IQR $26,731-$222,660) compared to CHD without MMC (median $27,726, $6463-$118,370) and MMC without CHD (median $40,066, IQR $5744-$97,490). Mortality was significantly higher in patients with MMC and CHD (22.2% compared to 3.1% in MMC without CHD and 4.1% in CHD without MMC). Significance remained when limiting for patients without genetic conditions or additional major birth defects. MMC with CHD in the newborn compared to either CHD or MMC alone is associated with longer LOS, higher charges, and increased mortality.

Trends in the prenatal diagnosis of trisomy 21 show younger maternal age and shift in the distribution of congenital heart disease over a 20-year period.

Prenatal testing has changed greatly over the past two decades, which may affect the diagnosis of congenital heart disease (CHD) in Down syndrome. The present study aimed to analyze changes in the prevalence and distribution of CHD diagnosed via ultrasonography and fetopathology in 462 fetuses with trisomy 21 between two consecutive 10-year periods (1999-2018), as well as the associations between CHDs, ultrasound markers, and extracardiac malformations. Overall, the frequency of cardiovascular malformations in trisomy 21 was 27.7 and 26.5%, and ultrasound identified 70 and 62% of CHDs during these periods. A profound increase in first-trimester ultrasound findings and associated anomalies with CHDs (ventricular septal defect, Tetralogy of Fallot) since 2009 were observed. Second-trimester nonstructural heart abnormalities were associated with ultrasound anomalies (74%) and major extracardiac malformations (42.9%). During both study periods, mothers carrying fetuses with CHD were significantly younger than those without CHD (p = 0.038, p = 0.009, respectively). Comparing the two 10-year periods, there were no changes in the prevalence and detection of CHDs. Trend analysis revealed that, although the frequency of CHD remained stable, the diagnostic spectrum had shifted between the study periods. Detection of nonstructural heart abnormalities necessitates detailed follow-up for cardiac/extracardiac malformations and chromosomal disorders.

What is the significance of hearing a heart murmur during the newborn physical examination?

Background Newborn screening for congenital heart disease (CHD) forms part of the newborn physical examination (NPE) in the UK. However, research has shown that up to 50% of cases of CHD can be missed by this examination. The purpose of this literature review is to investigate the significance of hearing an asymptomatic heart murmur at the NPE in relation to the presence of CHD. Methodology A critical literature review was conducted to answer the research question. The findings were discussed using a narrative synthesis approach. Findings There was considerable heterogeneity of results. The prevalence of murmur in newborns ranged between 0.6%–10.7%. Between 13%–67% of those newborns had some form of CHD, although many had clinically insignificant lesions. Between 2%–9% of newborns with murmurs had a form of critical CHD (CCHD). The ability to discern whether a heart murmur relates to pathology or not improves with experience. No single optimal timing for the NPE was identified. Pulse oximetry was shown to increase sensitivity of screening for CCHD. Conclusion There is a significant increase in the prevalence of CHD when a newborn has a heart murmur, hence referral for diagnostic echocardiography is required when a heart murmur is identified. Pulse oximetry is an important adjunct to newborn screening for CCHD. Some newborns affected by CCHD will not present with murmur at the NPE. Therefore, those caring for newborns during the early days must know the signs and symptoms of CHD so that appropriate medical assistance can be sought.

Prevalence of Congenital Heart Disease among Children in Khorramabad (West of Iran).

Congenital heart disease is among the most common congenital anomalies in pediatrics. The aim of this study was to evaluate the prevalence of congenital heart disease in children in Khorramabad, Iran. This is a descriptive-cross sectional study where all the children diagnosed with congenital heart disease by echocardiography were enrolled to the Shahid Madani Hospital. Patient information was collected by means of a questionnaire. Of 1600 children who underwent cardiac counseling, 9.75% presented congenital heart disease. These were most prevalent among the children of 0-28 days of the age (14.7%) and least in children aged 1 month-1 year. According to this study, atrial (20.3%) and ventricular septal defect (10.5%) were the most common heart defects, respectively. Among signs and symptoms of cardiac disease, 49.1% of children had cyanosis, 89.7% with increased CT (cardiothoracic)-ratio, and 82.7% of had heart murmur. Congenital heart disease was more prevalent in male infants (58%) and 6.6% patients had heart failure and 1.4% had other congenital conditions, such as Down syndrome. According to our findings, atrial and ventricular septal defects are the most common congenital heart anomalies, respectively, in pediatric patients in Khorramabad.

Incidence, pattern and presentation of Congenital Heart Disease in neonates in southern part of Bangladesh

Background: Congenital heart disease (CHD) has already been recognized as one of the important cause of neonatal mortality and morbidity. The reported prevalence of CHD in live newborns tends to vary a lot due to various unrecognizable lesions at birth and lack of technical expertise.&#x0D; Aims &amp; objectives: The ultimate aim of this study was to assess the birth incidence and pattern of congenital heart disease (CHD) using echocardiography in babies born in different government and private hospitals and also in different households.&#x0D; Results: Overall incidence of congenital heart disease in neonate in this study was 4.9 per 1000 live birth. Mean age of diagnosis was 22.5±4.6 days. Average weight of these neonates was 26.70 gm. 61.5 % neonates were female. 30.8% was preterm. Respiratory distress was the most common clinical presentation (76.9%). The commonest type of congenital heart disease was Ventricular septal defect (VSD) (61.5%). Maternal co-morbidity may have influence. 30.8% mothers had gestational diabetes mellitus. Hypothyroidism, hypertension and maternal infection may have co-relation.&#x0D; Conclusion: In this study, we have found that the overall incidence of neonatal congenital heart disease is 4.9 per 1000 live birth. A high index of suspicion and routine neonatal cheek-up may have key role in diagnosis.&#x0D; Mediscope Vol. 8, No. 1: January 2021, Page 27-32

Race and Genetics in Congenital Heart Disease: Application of iPSCs, Omics, and Machine Learning Technologies.

Congenital heart disease (CHD) is a multifaceted cardiovascular anomaly that occurs when there are structural abnormalities in the heart before birth. Although various risk factors are known to influence the development of this disease, a full comprehension of the etiology and treatment for different patient populations remains elusive. For instance, racial minorities are disproportionally affected by this disease and typically have worse prognosis, possibly due to environmental and genetic disparities. Although research into CHD has highlighted a wide range of causal factors, the reasons for these differences seen in different patient populations are not fully known. Cardiovascular disease modeling using induced pluripotent stem cells (iPSCs) is a novel approach for investigating possible genetic variants in CHD that may be race specific, making it a valuable tool to help solve the mystery of higher incidence and mortality rates among minorities. Herein, we first review the prevalence, risk factors, and genetics of CHD and then discuss the use of iPSCs, omics, and machine learning technologies to investigate the etiology of CHD and its connection to racial disparities. We also explore the translational potential of iPSC-based disease modeling combined with genome editing and high throughput drug screening platforms.