Congenital Heart Disease In Neonates Research Articles

A Survey on Cardiac Complications of COVID-19 in Infants

Congenital heart disease (CHD) may have serious effects on the course of COVID-19. Limited data were available on CHD in neonates with COVID-19. This study aimed to review the cardiac complications in neonates infected with COVID-19. Some studies showed that myocardial injury in adult patients is often correlated with a fatal outcome. But, scientific evidence in infants is rare, although several reports were published with the description of cardiac involvement in COVID-19 pediatric patients. In these young subjects, a background of surgically treated CHD seems to be a predisposing factor. Numerous studies showed Multisystem inflammatory syndrome in children (MIS-c) is a deadly demonstration of COVID-19 with cardiac involvement. The underlying pathophysiology of COVID-19-associated cardiovascular complications is not fully understood, although direct viral infection of the myocardium, systemic inflammatory response, coagulation abnormalities and thrombosis and hypoxia have been suggested as possible mechanisms of cardiac complications. It seems COVID-19 can affect different parts of the heart; however, the myocardium is more involved. The mechanisms of pathogenesis of cardiovascular implications in adults and infants are similar but CHD and MIS-c in infants are more important. Further studies on the effects of COVID-19 on the neonatal cardiovascular system are needed.

Surgical site infection after delayed sternal closure in neonates with congenital heart disease: retrospective case-control study

ObjectivesTo determine the prevalence of surgical site infections (SSIs) in neonatal congenital heart disease patients undergoing delayed sternal closure (DSC) and evaluate risk factors for SSI.MethodsHospital records of 483 consecutive neonates who underwent surgical intervention between January 2013 and December 2017 were reviewed, and perioperative variables were recorded.ResultsWe found that the prevalence of SSI was 87.5% when the body weight was less than 1500 g. When the operative age was between seven and 14 days, the probability of no SSI is about 93.9%. When the duration of the aortic cross-clamp was more than 60 min, the prevalence of SSI was 91.2%. The prevalence without SSI was 96.6% when the duration of DSC was less than 24 h. However, when the duration of DSC was more than 120 h, the prevalence of SSI was 88.9% (p = 0.000).ConclusionsWith the prolongation of aortic clamping duration, the probability of occurrence of SSI increased in neonatal CHD with DSC. The age at operation and body weight are closely related to the occurrence of SSI in neonatal CHD patients with DSC.

Redefining the Relationship: Palliative Care in Critical Perinatal and Neonatal Cardiac Patients.

Patients with perinatal and neonatal congenital heart disease (CHD) represent a unique population with higher morbidity and mortality compared to other neonatal patient groups. Despite an overall improvement in long-term survival, they often require chronic care of complex medical illnesses after hospital discharge, placing a high burden of responsibility on their families. Emerging literature reflects high levels of depression and anxiety which plague parents, starting as early as the time of prenatal diagnosis. In the current era of the global COVID-19 pandemic, the additive nature of significant stressors for both medical providers and families can have catastrophic consequences on communication and coping. Due to the high prognostic uncertainty of CHD, data suggests that early pediatric palliative care (PC) consultation may improve shared decision-making, communication, and coping, while minimizing unnecessary medical interventions. However, barriers to pediatric PC persist largely due to the perception that PC consultation is indicative of “giving up.” This review serves to highlight the evolving landscape of perinatal and neonatal CHD and the need for earlier and longitudinal integration of pediatric PC in order to provide high-quality, interdisciplinary care to patients and families.

Incidence and risk factors of congenital heart disease in Qingdao: a prospective cohort study

BackgroundMany studies have been conducted to assess the incidence of congenital heart disease (CHD). However, results were greatly inconsistent among these studies with a broad range of findings.MethodsA prospective census-based cohort study was conducted in Qingdao, China, from August 1, 2018 to April 30, 2019. All of the local registered pregnant women were continuously investigated and followed from 15 to 20 weeks of gestation to delivery, tracking the CHD cases in both the fetal and neonatal stages. A logistic regression model was applied to assess the association between CHD and possible risk factors.ResultsThe positive rate of prenatal CHD screening was 14.36 per 1000 fetuses and the incidence of CHD was 9.38 per 1000 live births. Results from logistic regression indicated that, living in the countryside (odds ratio, (OR): 0.771; 95% confidence interval, (CI): 0.628–0.946) and having a childbearing history (OR: 0.802; 95%CI: 0.676–0.951) were negatively associated with CHD. However, twin pregnancy (OR: 1.957, 95% CI: 1.245–3.076), illness in the first trimester (OR: 1.306; 95% CI: 1.048–1.628), a family history of CHD (OR: 7.156; 95% CI: 3.293–15.552), and having a child with a birth defect (OR: 2.086; 95% CI: 1.167–3.731) were positively associated with CHD.ConclusionCHD is a serious health problem in Qingdao. The CHD incidence found in this study was similar to existing research. The positive rate of prenatal CHD screening was higher than the incidence of neonatal CHD. Moreover, CHD risk factors were identified in our study, and our findings may have great implications for formation CHD intervention strategies.

A Study on Clinical Screening of Neonatal Congenital Heart Disease in Jinjiang City.

ObjectiveThis study explored the feasibility of congenital heart disease (CHD) screening by combining a percutaneous oxygen saturation (POX) test with cardiac auscultation method in neonates.MethodsPOX tests and cardiac auscultation were used concurrently to screen 8305 neonates born in Jinjiang City Hospital between January 2016 and December 2018 for CHD. The positive screening results (positive POX or positive cardiac auscultation) were confirmed with echocardiography, while any false negative results were identified through follow-up and parent feedback. Sensitivity, specificity, positive/negative predictive values, Youden’s index, and the area under the receiver operator characteristic curve (AUC) of the single use and combined use of the two methods (a POX test and auscultation) were calculated, and the results were compared.ResultsAmong 8305 neonates, 22 cases were positive for POX alone, of which 6 cases were diagnosed by echocardiography; 83 cases were positive for cardiac auscultation alone, of which 47 cases were diagnosed by echocardiography; and 8 cases were positive for both methods, all of which were confirmed by echocardiography. Four more cases were confirmed during follow-up. Sensitivity, specificity, and the positive and negative predictive values of combined screening were 93.85%, 99.37%, 53.98% and 99.95%, respectively, while Youden’s index was 0.93, and the AUC was 0.966. Sixty-five cases of CHD were diagnosed, the total incidence being 7.82%, and a ventricular septal defect was found to be the most common type.ConclusionThe combination of POX test and cardiac auscultation as a screening method for neonatal CHD can reduce missed diagnoses and increase the detection rate of CHD in newborn infants.

Diagnosis of Neonatal Congenital Heart Disease: A Combination of Heart Murmur, SpO2 Abnormality, Tachypnea, and Extracardiac Malformations

Congenital heart disease (CHD) is one of the commonest congenital malformations that are mostly asymptomatic at birth, which challenges the diagnosis of neonatal CHD. An early accurate prenatal diagnosis will give parents a choice, as well as the opportunity to plan the delivery and improve the postnatal outcome. The purpose of the study is to evaluate the value of heart murmurs, SpO2 abnormalities, tachypnea, and extracardiac malformations in screening neonatal CHD. All 4500 newborns in the obstetrics department of our hospital from January 2019 to January 2020 are selected as study subjects. Newborns were grouped according with the presence of heart murmurs, tachypnea, transdermalSpO2<95%,and extracardiac malformations alone or in combination (≥3). Patients with murmur, tachypnea, and abnormal SpO2 were assigned into group A, those with murmur, tachypnea, and extracardiac malformations into group B, those with murmurs, SpO2, and extracardiac malformations into group C, those with SpO2, tachypnea, and extracardiac malformations into group D, and those with all four into group E. The color echocardiography identified 65 children with CHD (1.4%) among the included 4,500 newborns. When murmur, tachypnea, abnormal SpO2, and extracardiac malformation were independently used to diagnose CHD, the sensitivity ranged from 30.68% to 51.26%, with specificity ranging from 47.36% to 82.65% and Youden’s index (YI) ranging from 0.13 to 0.36. When murmur, tachypnea, abnormal SpO2, extracardiac malformation were together used to diagnose CHD, 91.23% sensitivity, 95.26 specificity, and 0.91 YI were observed. In conclusion, a combination of four indicators, murmur, tachypnea, abnormal SpO2, and extracardiac malformation yielded good performance in diagnosing neonatal CHD.

Diagnostic value of pulse oximetry combined with cardiac auscultation in screening congenital heart disease in neonates.

ObjectiveThis study aimed to investigate the feasibility and reliability of pulse oximetry combined with cardiac auscultation in screening neonatal congenital heart disease (CHD).MethodsThis was a retrospective, observational, screening study. All newborns included in the study were at the Second Affiliated Hospital of Wenzhou Medical University from July 2019 to January 2020. Primary screening of CHD was conducted by pulse oximetry combined with cardiac auscultation assays. Indices, including sensitivity, specificity, the positive/negative predictive value, the positive/negative likelihood ratio, and the diagnostic odds ratio, were calculated. The area under the relative operating characteristic curve of the subjects was measured.ResultsA total of 3327 neonates were enrolled, among whom 139 were diagnosed with CHD and the incidence of CHD was 4.2%. The sensitivity, specificity, diagnostic odds ratio, and area under the relative operating characteristic curve of pulse oximetry combined with cardiac auscultation were 89.9%, 94.7%, 169.0, and 0.923, respectively.ConclusionsPulse oximetry combined with cardiac auscultation is a novel screening method with acceptable accuracy and feasibility for neonatal CHD. This combination method is worth promoting widely.

The Association of Maternal Hypertensive Disorders With Neonatal Congenital Heart Disease: Analysis of a United States Cohort

(Abstracted from J Perinatol 2020;40(11):1617–1624) One of the more common causes of maternal and perinatal mortality is hypertensive disorders of pregnancy (HDPs). Hypertension affects up to 10% of pregnancies and has been associated with an increased risk of congenital heart disease (CHD) in offspring.

Is Early Extubation Associated with Better Outcomes After Neonatal Congenital Heart Disease Surgery?

Early extubation (EE) of children after surgery (occurring within the operating room or ≤ 6 hours postadmission) for congenital heart disease (CHD) has been advocated to improve postoperative care. The objective of this study is to compare outcomes of neonates undergoing EE following CHD surgical repair with those extubated more than 6 hours after surgery. Retrospective cohort study utilizes data from the Virtual Pediatric Systems database. Data from neonates undergoing surgical repair for six common CHD lesions and admitted to 57 pediatric intensive care units (ICUs) between July 1, 2010, and June 30, 2015, were analyzed. A total of 1,274 neonates were analyzed; 100 (7.8%) had EE, and 146 (11.5%) were extubated > 6 hours but ≤ 24 hours. Most patients (80.4%) were extubated > 24 hours. The EE group had higher ( p < 0.001) failed extubation rate than patients extubated at any other time; a multivariate analysis of linear regression showed no advantage in length of stay (LOS) of EE compared with those subjects who were extubated in the first 24 hours ( p -value: 0.178). Extubation failure was found to impact ICU LOS in this analysis. The ICU LOS was increased by 3.5 days for every failed extubation attempt ( p -value: <0.001, 95% confidence interval: 1.6-5.5 days). EE after CHD surgery is possible. Though it appears as an attractive option to decrease potential mechanical ventilation complications, this study of neonates shows that EE might result in worse outcomes than when performing extubation between 6 and 24 hours postoperatively.

Feasibility of using a non-sedation protocol for evaluation of neonatal congenital heart disease by using a 16-cm wide-detector computed tomography with a low radiation dose: preliminary experience from a single pediatric medical center.

The aim of this study is to explore the feasibility of using a non-sedation protocol for the evaluation of neonatal congenital heart disease by using 16-cm wide-detector CT with a low radiation dose. Thirty-four neonates (group 1) were enrolled to undergo cardiac CT without sedation between August 2018 and March 2019. The control group (group 2) comprising 20 inpatient neonates was sedated. Cardiac CT was performed using 16-cm area detector 320-row CT with free breathing and prospective ECG-triggering scan mode. The examination completion time, radiation dose, and image quality were compared between the groups. The results of cardiac CT for patients in group 1 who underwent surgery were compared with surgical findings. Intergroup differences in body weight, age, examination completion time, radiation dose, and image quality evaluation were not significant. There was no significant difference in oxygen saturation before and after the examination in group 1. In all, 98 separate cardiovascular abnormalities in 27 group 1 patients were confirmed using surgical reports. The overall sensitivity, specificity, positive predictive value, and negative predictive value of cardiac CT were 94.90%, 100.0%, 100.0%, and 98.53%. The non-sedation protocol can be applied in neonates with congenital heart disease by using 16-cm wide-detector CT with a low radiation dose. Based on the image quality obtained, non-sedative examination did not extend the examination completion time and helped avoid the possible side effects of sedative drugs.

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

Tissue engineering: Relevance to neonatal congenital heart disease

Congenital heart disease (CHD) represents a large clinical burden, representing the most common cause of birth defect-related death in the newborn. The mainstay of treatment for CHD remains palliative surgery using prosthetic vascular grafts and valves. These devices have limited effectiveness in pediatric patients due to thrombosis, infection, limited endothelialization, and a lack of growth potential. Tissue engineering has shown promise in providing new solutions for pediatric CHD patients through the development of tissue engineered vascular grafts, heart patches, and heart valves. In this review, we examine the current surgical treatments for congenital heart disease and the research being conducted to create tissue engineered products for these patients. While much research remains to be done before tissue engineering becomes a mainstay of clinical treatment for CHD patients, developments have been progressing rapidly towards translation of tissue engineering devices to the clinic.

Critical Congenital Heart Disease in Neonates: A Review Article.

Critical congenital heart defects (CCHDs) are serious malformations that remain to be an important cause of neonatal mortality and morbidity. The clinical presentations of CCHD are shock, cyanosis, or respiratory distress, which may be similar to that of other neonatal conditions. Failure to diagnose these conditions early on after birth may result in acute cardiovascular collapse and death. Screening with routine pulse oximetry is efficient in distinguishing newborns with CCHD and other hypoxemic illnesses, which may otherwise be potentially life-threatening. If the cardiovascular system cannot be observed by echocardiography, then treatment with continuous prostaglandin-E1(PGE1) infusion should be started in any newborn whose condition deteriorates in the first few days of life. This review aims to provide a concise summary of the presentation and management of various CCHDs and to emphasize the role of timely diagnosis in the management.

Evaluation of neonatal acute kidney injury after critical congenital heart disease surgery.

Acute kidney injury (AKI) is a common complication of congenital heart diseases (CHDs) after cardiac surgery. This study aimed to define the frequency and critical course, risk factors and short-term outcomes of AKI in postoperative CHD neonates. Postoperatively followed term CHD newborn infants were enrolled in the study. Infants with congenital anomalies of the urinary tract and other major congenital anomalies were excluded. Neonatal modified KDIGO criteria were used to assess AKI. A total of 199 postoperatively followed newborn infants were included in the study. Acute kidney injury was detected in 71 (35.6%) patients. Of these patients, 24 (33.8%) were in stage 1, 14 (19.7%) in stage 2, and 33 (46.5%) in stage 3. Acute kidney injury occurred within the first week (median 1 day [IQR 1-2 days]) of cardiac surgery in 93% of the patients. The duration of invasive respiratory support and extracorporeal membrane oxygenation (ECMO) and mortality were significantly higher in stage 3 patients. Higher vasoactive-inotropic score (OR, 1.02; 95% CI, 1.0-1.04; p = 0.008) and receiving ECMO (OR, 7.9; 95% CI, 2.6-24.4; p = 0.001) were associated with risk for the development of AKI. The mortality rate was 52.1% in the AKI (+) patients, and having AKI (OR 7.1; 95% CI, 3.5-14.18) was significantly associated with mortality. Acute kidney injury, a common early complication after critical neonatal CHD cardiac surgery, is associated with increased morbidity and mortality. Stage 3 AKI is associated with significantly higher mortality rates.

CLASSIFICATION OF VENTRICULAR SEPTAL DEFECTS (VSDS) ON THE BASIS OF GENETICS

Ventricular Septal Defects (VSDs) account for 30% to 60% of all congenital heart diseases in neonates. VSDs are one of the commonest abnormalities, affecting human heart and has been the focus of interest in several studies since years. Strong evidence regarding the involvement of genes in causing VSDs has been accumulated over the years. The classification based on genetics, including three types of VSDs; VSD1, VSD2 and VSD3, is the focus of this paper.

Additional value and new insights by four-dimensional flow magnetic resonance imaging in congenital heart disease: application in neonates and young children

Cardiovascular MRI has become an essential imaging modality in children with congenital heart disease (CHD) in the last 15–20 years. With use of appropriate sequences, it provides important information on cardiovascular anatomy, blood flow and function for initial diagnosis and post-surgical or -interventional monitoring in children. Although considered as more sophisticated and challenging than CT, in particular in neonates and infants, MRI is able to provide information on intra- and extracardiac haemodynamics, in contrast to CT. In recent years, four-dimensional (4-D) flow MRI has emerged as an additional MR technique for retrospective assessment and visualisation of blood flow within the heart and any vessel of interest within the acquired three-dimensional (3-D) volume. Its application in young children requires special adaptations for the smaller vessel size and faster heart rate compared to adolescents or adults. In this article, we provide an overview of 4-D flow MRI in various types of complex CHD in neonates and infants to demonstrate its potential indications and beneficial application for optimised individual cardiovascular assessment. We focus on its application in clinical routine cardiovascular workup and, in addition, show some examples with pathologies other than CHD to highlight that 4-D flow MRI yields new insights in disease understanding and therapy planning. We shortly review the essentials of 4-D flow data acquisition, pre- and post-processing techniques in neonates, infants and young children. Finally, we conclude with some details on accuracy, limitations and pitfalls of the technique.

Evaluation of Circulating Cardiovascular Biomarker Levels for Early Detection of Congenital Heart Disease in Newborns in Sweden

Congenital heart disease (CHD) is the most common congenital malformation in humans worldwide. Circulating cardiovascular biomarkers could potentially improve the early detection of CHD, even in asymptomatic newborns. To assess the performance of a dried blood spot (DBS) test to measure the cardiovascular biomarker amino terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) levels in newborns and to compare DBS with standard EDTA analysis in control newborns during the first week of life. This diagnostic study was conducted in a single regional pediatric service in southern Sweden. Healthy, term neonates born between July 1, 2018, and May 31, 2019, were prospectively enrolled and compared against retrospectively identified newborns with CHD born between September 1, 2003, and September 30, 2019. Neonates who required inpatient treatment beyond the standard postnatal care were excluded. New DBS test for NT-proBNP quantification in newborns that used 3 μL of blood vs the current screening standard. Performance of the new test and when combined with pulse oximetry screening was measured by receiver operating characteristic curve analysis. Performance of the new test and EDTA screening was compared using Pearson linear correlation analysis. The DBS samples of 115 neonates (81 control newborns and 34 newborns with CHD, of whom 63 were boys [55%] and the mean [SD] gestational age was 39.6 [1.4] weeks) were analyzed. The new NT-proBNP test alone identified 71% (n = 24 of 34) of all CHD cases and 68% (n = 13 of 19) of critical CHD cases as soon as 2 days after birth. Detection of any CHD type improved to 82% (n = 28 of 34 newborns) and detection of critical CHD improved to 89% (n = 17 of 19 newborns) when combined pulse oximetry screening and NT-proBNP test results were used. Performance of the NT-proBNP test was excellent when control newborns were matched to newborns with CHD born between July 1, 2018, and May 31, 2019 (area under the curve, 0.96; SE, 0.027; 95% CI, 0.908-1.0; asymptotic P < .05). This study found that NT-proBNP assay using minimal DBS samples appears to be timely and accurate in detecting CHD in newborns and to discriminate well between healthy newborns and newborns with various types of CHD. This finding warrants further studies in larger cohorts and highlights the potential of NT-proBNP to improve neonatal CHD screening.

Critical Neonatal Congenital Heart Disease – a Rare Complication after Successful Surgical Correction

Abstract Pulmonary arterial hypertension (PAH) is a rare but severe complication that should be investigated in patients diagnosed with transposition of the great arteries who have undergone neonatal arterial switch operation. Early diagnosis and aggressive combination therapy for PAH could help to improve survival in these patients. We report a favorable clinical response 6 months after the initiation of vasodilator therapy in a pediatric case with transposition of the great arteries, successfully repaired in the neonatal period, who developed pulmonary arterial hypertension at the age of 5 years.

Clinical Profile, Pattern of Presentation and Short Term Outcome of Cyanotic Congenital Heart Disease in Neonates

Clinical Profile, Pattern of Presentation and Short Term Outcome of Cyanotic Congenital Heart Disease in Neonates

The association of maternal hypertensive disorders with neonatal congenital heart disease: analysis of a United States cohort.

To examine the association of any type of maternal hypertensive disorders of pregnancy (HDP) and neonatal congenital heart diseases (CHD). We compared the prevalence of CHD between neonates born to mothers with HDP to those delivered to mothers without HDP among 24,525,889 hospital records of living infants, from a national database. We controlled for multiple confounding factors by using multiple logistic regression analysis. Infants delivered to mothers with HDP had higher prevalence of CHD compared to infants born to mothers without HDP [5.20% vs. 1.47%; aOR: 2.51(2.38-2.64), p < 0.001]. Maternal diabetes was more frequent among infants born to mothers with HDP and was independently associated with CHD [aOR 5.14 (5.04-5.23), p < 0.001]. Infants born to mothers with hypertension had almost a threefold increase in CHD compared with those born to mothers without hypertension. Further studies are needed to investigate the underlying mechanism and direction of this association.