Congenital Heart Disease In Neonates Research Articles

Comparison of Congenital Heart Disease between Neonates Born to Diabetic and Non-diabetic Mothers

Background: Congenital heart disease (CHD) contributes about one-third of all major congenital anomalies in the world among the neonates, most common in infants of diabetic mothers but incidence is increasing all over the world due to establishing cardiac investigation facilities especially neonatal echocardiogram. Materials & Methods: A hospital-based cross-sectional study was done in two private hospitals in Dhaka from July ’19 to June ’20. A total of 90 neonates were included from nursery and neonatal intensive care units of both hospitals who were requested for echocardiography as suspected CHD. Results: In our study 52% mothers had diabetes mellitus (DM) during this conception and remains were normoglycemic. CHD present in 41.11% non-DM & DM mother’s offspring, there was no significant statistical difference among the groups (p=0.535). Gestational age and maternal coexisting diseases caused little impact on CHD in neonates (p <0.1). Regarding neonatal conditions only respiratory distress was significantly associated with CHD at p<0.05 level. Conclusions: Researcher according to our study diabetes mellitus does not contribute to CHD in neonates. Researcher can focus on other maternal comorbidities and other factors like respiratory distress and cyanosis after birth, which may contribute to CHD in neonates. J Bangladesh Coll Phys Surg 2023; 41: 27-32

The prenatal weekly temperature exposure and neonatal congenital heart disease: a large population-based observational study in China.

We aim to explore the link between maternal weekly temperature exposure and CHD in offspring and identify the relative contributions from heat and cold and from moderate and extreme atmospheric temperature. From January 2019 to December 2020, newborns who were diagnosed with CHD by echocardiography in the Network Platform for Congenital Heart Disease (NPCHD) from 11 cities in eastern China were enrolled in the present study. We appraised the exposure lag response relationship between temperature and CHDs in the distributed lag nonlinear model and further probed the pooled estimates by multivariate meta-analysis. We further performed the exposure-response curves in extreme temperature (5th percentile for cold and 95th for hot events). We also delve into the cumulative risk ratios (CRRs) of temperature on CHDs in general and subgroups. In this study, 5904 of 983, 523 infants were diagnosed with CHDs. The temperature-CHD combination performed positive significance in two exposure windows, gestational weeks 10-16 and 26-31, and reached the maximum effect in the 28th week. Compared with extreme cold (5th, 6.14℃), these effects were higher in extreme heat (95th, 29.26℃). The cumulative exposure-response curve showed a steep nonlinear rise in the hot tail but showed non-significance at low temperatures. In this range, the CRRs of temperature showed an increment to a ceiling of 3.781 (95% CI: 1.460-10.723). The temperature- CHD curves for both sex groups showed a general growth trend. No statistical significance was observed between these two groups (P = 0.106). The cumulative effect of the temperature related CHD was significant in regions with lower education levels (maximum CRR was 9.282 (3.019-28.535)). A degree centigrade increase in temperature exposure was associated with the increment of CHD risk in the first and second trimesters, especially in extreme heat. Neonates born in lower education regions were more vulnerable to temperature-related CHDs.

Pulse Oximetry Screening for Detecting Critical Congenital Heart Disease in Neonates.

Background Congenital heart disease(CHD) leads to significant morbidity in the neonatal population and is a crucial disorder behind early infancy death rates. Mosthave a critical congenital heart defect (Cr CHD) out of all the heart defects found in babies. A subgroup of cardiac anomalies needssurgery or catheter intervention during the neonatal period. Pulse oximetry is a good screening tool to detect cr CHDin neonates. This study aims to assess the effectiveness of pulse oximetry as a screening toolin a rural setting. Methods This was a hospital-based prospective observational study. All consecutively born neonates whose parents consented to the study were subjected to pulse oximetry on all four limbs. Their peripheral arterial oxygen saturation was measured on days one, two, and three of life, starting four hours after birth. Babies detected with cyanotic congenital heart disease (CCHD) before birth are not a part of this study. All those with arterial oxygen saturation of less than 95% or a difference of saturation of more than 3% in the upper and lower limbs were considered suspects for Cr CHD and subjected to echocardiography. Results Among 5874 neonates studied, researchers found 164 babies to have significant hypoxemia on pulse oximetry, and 44CHD were detected on echocardiography within the first three days of life (positive predictive value (PPV) 12.2%). The physician referred all of them to a higher center before further delay. Thirty-four babies with other congenital heart diseases were found using pulse oximetry examination. Also, 108cases of hypoxemia due to other causes were found and monitored. Conclusion Critical congenital heart diseases are a significant cause of death among neonates and require early diagnosis and emergent medical and surgical management. They are associated with hypoxemia, and this principle can be used to screen them using a pulse oximeter.

Evaluation of the Prevalence of Congenital Heart Diseases in neonates of Ilam province of Iran, in 2019-2020

Evaluation of the Prevalence of Congenital Heart Diseases in neonates of Ilam province of Iran, in 2019-2020

Neonatal Congenital Heart Disease Surgical Readiness and Timing.

Neonatal Congenital Heart Disease Surgical Readiness and Timing.

Clinical Screening of Congenital Heart Disease in Neonates: a Literature Review on Five Studies

Background: Diagnosing Congenital Heart Disease (CHD), particularly critical CHD in newborns, could be difficult but crucial, since the field of congenital heart surgery has shifted from initial palliation followed by final correction at a later age to stressing early repair even in the youngest individuals. Although echocardiography remains the gold standard for diagnosing CHD, simple clinical examination may be helpful in screening neonates who require further investigation and treatment. In this study, we searched and reviewed the literature on clinical screening for CHD using a simple, affordable tool that is readily available in primary health care facilities, to prove that early simple clinical examination would help physician to screen for asymptomatic CHD.Methods: We searched articles on google scholars that discuss clinical screening of CHD in neonates. Inclusion criteria is articles published within five years and exclusion criteria is articles published older than five years.Results: We found five articles eligible and pick consecutively. We found that pulse oximetry sensitivity and specificity ranged from 21.54%-77.3% and 82.65%-99.9%, respectively. Cardiac auscultation with murmur of grade ≥2 as count as positive, having high range of sensitivity and specificity, with sensitivity ranged from 17.3%-89.58% and specificity ranged from 47.36%-99.69%. When pulse oximetry and cardiac auscultation combined, three studies found that the sensitivity and specificity increased dramatically, 89.9%-95.5%, 94.7%-99.37%, respectively. Conclusion: Both cardiac auscultation and pulse oximetry was an easy, feasible method with readily available basic tools at all hospital with acceptable sensitivity and specificity to screening CHD before suspected neonates undergo echocardiography, therefore making CHD diagnosed more effective and efficient.

Pregnancy outcomes in women with Ebstein's anomaly: data from the EORP Registry of Pregnancy and Cardiac Disease (ROPAC)

Abstract Background Ebstein's anomaly is a rare congenital cardiac condition characterized by displacement of the posterior and septal leaflets of the tricuspid valve towards the apex of the right ventricle. The ESC Guidelines for the management of cardiovascular diseases during pregnancy categorize women with uncomplicated Ebstein's anomaly as modified World Health Organization (mWHO) risk class II. However, data regarding pregnancy outcomes in women with Ebstein's anomaly are scarce. Purpose To evaluate the maternal and perinatal risks of pregnancy in women with Ebstein's anomaly. Methods All patients with Ebstein's anomaly who had been included in the Registry of Pregnancy and Cardiac Disease (ROPAC), which is an international, prospective, observational registry of pregnant women with underlying cardiac disease (n=5739), were evaluated. The primary outcome was the occurrence of a major adverse cardiac event, defined as maternal mortality, heart failure, arrhythmia, thromboembolic events or endocarditis. The secondary outcomes were obstetric and perinatal outcomes and the influence of pregnancy on tricuspid valve regurgitation. Results Thirty-six hospitals in 22 countries enrolled 81 women with Ebstein's anomaly (mean age 29.7 years, 46.9% nulliparous). Seven (8.6%) women had a history of tricuspid valve repair and a further eight (9.9%) of tricuspid replacement. Most women (67.9%) were in NYHA class I. At least one major adverse cardiac event occurred in 8 (9.9%) pregnancies, including heart failure (n=6), supraventricular arrhythmia (n=3) and thromboembolic events (n=2). There was no maternal death. Almost half of the women underwent a Caesarean section (49%) and preterm delivery occurred in 24.7%. Neonatal mortality was 2.5% and four (4.9%) infants had neonatal congenital heart disease. Serial echocardiographic data pre- and postpregnancy were available in 14 women. There was no clear deterioration in tricuspid regurgitation (see Picture 1). Conclusion Although mortality was zero, in 10% of the pregnant women with Ebstein's anomaly a major adverse cardiac event occurred, most frequently heart failure or arrhythmia. Therefore, women with Ebstein's anomaly should be categorized as mWHO risk class II at least, but perhaps more correctly as II–III. Preconception counseling is crucial, so that women are aware of the potential risks of maternal morbidity, preterm delivery and congenital heart disease and the need for careful monitoring during pregnancy. Funding Acknowledgement Type of funding sources: None.

Practice variations for fetal and neonatal congenital heart disease within the Children's Hospitals Neonatal Consortium.

Many aspects of care for fetuses and neonates with congenital heart disease (CHD) fall outside standard practice guidelines, leading to the potential for significant variation in clinical care for this vulnerable population. We conducted a cross-sectional survey of site sponsors of the Children's Hospitals Neonatal Consortium, a multicenter collaborative of 41 Level IV neonatal intensive care units to assess key areas of clinical practice variability for patients with fetal and neonatal CHD. We received responses from 31 centers. Fetal consult services are shared by neonatology and pediatric cardiology at 70% of centers. Three centers (10%) routinely perform fetal magnetic resonance imaging (MRI) for women with pregnancies complicated by fetal CHD. Genetic testing for CHD patients is routine at 76% of centers. Preoperative brain MRI is standard practice at 5 centers (17%), while cerebral NIRS monitoring is regularly used at 14 centers (48%). Use of electroencephalogram (EEG) after major cardiac surgery is routine in 5 centers (17%). Neurodevelopmental follow-up programs are offered at 30 centers (97%). Many aspects of fetal and neonatal CHD care are highly variable with evolving shared multidisciplinary models. Many aspects of fetal and neonatal CHD care are highly variable. Genetic testing, placental examination, preoperative neuroimaging, and postoperative EEG monitoring carry a high yield of finding abnormalities in patients with CHD and these tests may contribute to more precise prognostication and improve care. Evidence-based standards for prenatal and postnatal CHD care may decrease inter-center variability.

Meeting Parents' Needs for Education and Preparation following Congenital Heart Disease Diagnosis: Recommendations from a Crowdsourced Study.

This article characterizes the educational needs of parents following fetal or neonatal congenital heart disease (CHD) diagnosis and generates recommendations for meeting these needs. Online crowdsourcing methods were used to collect qualitative data from 95 parents of children with CHD regarding their needs for education and preparation following fetal or neonatal diagnosis. Data were analyzed using qualitative methods and themes were organized around the substructure of met and unmet needs. Two themes represented consistently met needs, whereas 10 themes represented needs that were either inconsistently met or consistently unmet. Parents reported needing more information about social, emotional, and financial supports, preparation for long-term care, and guidance toward reputable online resources. Parents also provided recommendations for meeting these needs. Parents' needs for education and preparation following CHD diagnosis are much broader in scope than what they currently receive. Addressing these may support parental coping and active participation in medical decision-making. · CHD counseling after diagnosis may provide opportunities to promote parents' mental health.. · Guidelines recommend that this counseling should include emotional and decision-making support, however, it is unclear what parents actually receive.. · This study found that parents' needs for education and preparation following CHD diagnosis are much broader in scope than what they currently receive..

Large scale application of pulse oximeter and auscultation in screening of neonatal congenital heart disease

PurposeTo conduct a retrospective evaluation of a large clinical implementation of combined pulse oximeter (POX) and cardiac auscultation as a fast-screening device for congenital heart disease (CHD).MethodsEvery newborn in a large maternity healthcare center received auscultation and POX screening within 24 hours after delivery. When an abnormal heart murmur or SpO2 level was detected, an echocardiogram was ordered to confirm the diagnosis of CHD.ResultsFrom January 1, 2018 to December 31, 2019, there were 44,147 livebirths at the studied hospital where 498 suspected CHD were identified: 27 newborns by POX screening and 471 by cardiac auscultation. The diagnosis was further confirmed in 458 neonates through echocardiogram. This result put forth an overall diagnosis rate of 92.0%. Cardiac auscultation detected the majority of CHD cases 438 (95.6%) while POX only screened 20 (4.4%) cases. Interestingly, no CHD case was detected by both auscultation examination and POX screening. Auscultation detected most of the common types of CHD, but POX excelled in identifying rare and critical cases. POX screening alone had a very low accuracy of 74.07% in positive predict value (PPV). On the other hand, auscultation functioned well in terms of PPV and negative predict value (NPV) (92.99 and 99.95%, respectively), but the addition of POX improved the overall screening performance resulting in 100% NPV. We also validate the finding with the data 6 months after the study period.ConclusionOur study demonstrated that addition of pulse oximetry to routine cardiac auscultation could be used as an accurate and feasible screening for early screening of CHD in newborns in large-scale clinical practice.

Prevalence of Congenital Heart Diseases in Neonates of Diabetic Mothers: A Cross Sectional Study in Yazd

Background: Maternal hyperglycemia is a critical risk factor for congenital heart diseases (CHD). Despite advancements in the medical management of diabetic mothers, the CHD in their infants are still more recurring compared to infants of the general population. The primary purpose of this investigation was to explore the prevalence of CHD in infants of diabetic mothers (IDMs). The study was also aimed at investigating possible associations between the types of maternal diabetes with the incidence of CHD in IDMs especially the status of diabetic control.
 Methods: This cross-sectional study was performed between October 2016 and September 2017, in a Heart Center in Yazd. The cases were comprised of 150 neonates of mothers with diabetes. We determined CHD via fetal echocardiography during the first day of childbirth and estimated the prevalence of CHD in IDMs and its association to control status of diabetes in mothers.
 Results: The prevalence of CHD in IDMs was 12.7%. The results showed that there was a significant relationship between maternal uncontrolled diabetes and a high incidence of CHD in IDMs (P ≤ 0.0001), but there was no association between the type of diabetes and the incidence of HCM.
 Conclusion: We concluded that controlling maternal diabetes has the greatest effect on the prevention of CHD in neonates. The prevalence of CHD in IDMs was 12.7% which is high that may be due to poor control of diabetes in pregnant women in Iran. Also, neonates of diabetic mothers need more cardiac evaluation tests and follow-ups. Therefore, more studies on the effects of maternal diabetes-induced CHD in neonates are needed.

Analysis of related risk factors for neonatal congenital heart disease.

Analysis of related risk factors for neonatal congenital heart disease.

Clinical implications of acute shunt thrombosis in paediatric patients with systemic-to-pulmonary shunt re-interventions.

Systemic-to-pulmonary shunts are used as a source of pulmonary blood flow in palliated Congenital Heart Disease in neonates and young infants. Shunt thrombosis, often requiring shunt interventions during index hospitalisation, is associated with poor outcomes. We hypothesised that extensive use of perioperative pro-coagulant products may be associated with shunt thrombosis. Children (≤18 years) undergoing systemic-to-pulmonary shunts with in-hospital shunt reinterventions between 2016 and 2020 were reviewed retrospectively. Perioperative associations to shunt thrombosis were examined by univariate logistic regression and Wilcoxon rank sum tests as appropriate. Cox and log transformed linear regression were used to analyse postoperative ventilation duration, length of stay, and cost. Of 71 patients requiring in-hospital shunt intervention after systemic-to-pulmonary shunts, 10 (14%) had acute shunt thrombosis, and among them five (50%) died. The median age was four (interquartile range: 0-15) months. There were 40 (56%) males, 41 (58%) had single ventricle anatomy, and 29 (40%) were on preoperative anticoagulants. Patients with acute shunt thrombosis received greater volume of platelets (p = 0.04), cryoprecipitate (p = 0.02), and plasma (p = 0.04) postoperatively in the ICU; experienced more complications (p = 0.01) including re-exploration for bleeding (p = 0.008) and death (p = 0.02), had longer hospital length of stays (p = 0.004), greater frequency of other arterial/venous thrombosis (p = 0.02), and greater hospital costs (p = 0.002). Patients who develop acute shunt thrombosis receive more blood products perioperatively and experience worse hospital outcomes and higher hospital costs. Future research on prevention/early detection of shunt thrombosis is needed to improve outcomes in infants after systemic-to-pulmonary shunt surgery.

Neuromonitoring, neuroimaging, and neurodevelopmental follow-up practices in neonatal congenital heart disease: a European survey

BackgroundBrain injury and neurodevelopmental impairment remain a concern in children with complex congenital heart disease (CHD). A practice guideline on neuromonitoring, neuroimaging, and neurodevelopmental follow-up in CHD patients undergoing cardiopulmonary bypass surgery is lacking. The aim of this survey was to systematically evaluate the current practice in centers across Europe.MethodsAn online-based structured survey was sent to pediatric cardiac surgical centers across Europe between April 2019 and June 2020. Results were summarized by descriptive statistics.ResultsValid responses were received by 25 European centers, of which 23 completed the questionnaire to the last page. Near-infrared spectroscopy was the most commonly used neuromonitoring modality used in 64, 80, and 72% preoperatively, intraoperatively, and postoperatively, respectively. Neuroimaging was most commonly performed by means of cranial ultrasound in 96 and 84% preoperatively and postoperatively, respectively. Magnetic resonance imaging was obtained in 72 and 44% preoperatively and postoperatively, respectively, but was predominantly reserved for clinically symptomatic patients (preoperatively 67%, postoperatively 64%). Neurodevelopmental follow-up was implemented in 40% of centers and planned in 24%.ConclusionsHeterogeneity in perioperative neuromonitoring and neuroimaging practice in CHD in centers across Europe is large. The need for neurodevelopmental follow-up has been recognized. A clear practice guideline is urgently needed.ImpactThere is large heterogeneity in neuromonitoring, neuroimaging, and neurodevelopmental follow-up practices among European centers caring for neonates with complex congenital heart disease.This study provides a systematic evaluation of the current neuromonitoring, neuroimaging, and neurodevelopmental follow-up practice in Europe.The results of this survey may serve as the basis for developing a clear practice guideline that could help to early detect and prevent neurological and neurodevelopmental sequelae in neonates with complex congenital heart disease.

Evaluation of acute kidney injury after surgery for congenital heart disease in neonates: a tertiary hospital experience

Purpose of the article Acute kidney injury (AKI) after cardiac surgery in children with congenital heart disease (CHD) is a serious complication closely associated with high morbidity and mortality. Despite numerous studies on AKI in children, most studies have excluded neonates. We sought to characterize AKI associated with cardiac surgery in neonates, determine its incidence, perioperative and postoperative risk factors, and short-term results. Materials and methods This retrospective study included 177 neonates who were operated on for CHD in our hospital between January 2015 and December 2019. Data of the patients were analyzed according to nKDIGO (neonatal Kidney Disease Improving Global Outcomes) and nRIFLE (neonatal Risk, Injury, Failure, Loss of function, End-stage kidney disease) criteria for evaluating AKI retrospectively. Data of groups with and without AKI were analyzed. Results The average age of 177 neonates were 8.2 ± 6.1 (1–28) days. Twenty-two (12.4%) neonates had CS-AKI defined according to nKDIGO criteria. Four (2.3%) neonates reached nKDIGO stage I, 1 (0.6%) reached stage II, 17 (9.6%) reached stage III. Thirty-eight (21.5%) neonates had CS-AKI defined according to nRIFLE criteria. Twenty-four (13.6%) neonates reached nRIFLE stage risk(R), 6 (3.4%) reached stage injury(I), 8 (4.5%) reached stage failure (F). The incidence of cardiac surgery-associated acute kidney injury (CS-AKI) in neonates was 12.5% and 21.5% for nKDIGO and nRIFLE, respectively. The percentage difference between nKDIGO and nRIFLE for AKI assessment was due to the criteria for nRIFLE stage risk(R) urine output < 1.5 mL/kg/h for 24 h. In both classifications, the duration of cardiopulmonary bypass, operation, inotropic treatment, and mechanical ventilation, length of intensive care unit (ICU), and hospital stay were significantly higher in the AKI group than those without AKI group (p˂.05). The mortality rate in the groups with AKI was found to be significantly higher (p˂.05) than in the groups without AKI. In Kappa analysis, when two classifications were compared according to AKI stages, a significant agreement was found between nKDIGO and nRIFLE classifications (p˂.05) (Kappa: 0.299). Conclusion AKI and mortality rates were similar between groups according to the nKDIGO and nRIFLE criteria. For early prediction of AKI and adverse outcomes, diagnostic reference intervals might be specified in more detail in neonates undergoing cardiac surgery for CHD.

THE ROLE OF PULSE OXIMETRY IN THE EARLY DETECTION OF CONGENITAL HEART DISEASE IN NEONATES BEFORE HOSPITAL DISCHARGE

Objectives: Infant screening for congenital heart disease (CHD) includes a straightforward bedside test called pulse oximetry. Low degrees of oxygen in the blood can be an indication of a critical CHD. The aim of the present study was to evaluate the role of pulse oximetry in the early detection of asymptomatic CHD in new borns before discharge from Hospital. Methodology: This cross-sectional study conducted on 3151 term neonates first stage of SPO2 was performed 2-12 hours after birth. If SPO2 was &lt; 95%, premeasured within the first 12 to 24 hours of life. If the neonates maintained their SPO2 &lt;95, they shifted to pediatric cardiologist for echocardiography. For the statistical analyses, SPSS 18.0 (SPSS Inc., Chicago, IL) was used. The significant level considered less than 0.05. Results: From 3151 neonates, 29 individuals had SPO2&lt;95% in which 26 went under echocardiography and 3 missed. In these neonates 22 had CHD. The SPO2 had a diagnostic value of 85%. Maternal age and neonates’ height at birth not changed based on healthy status and SPO2 levels. Gestational age had no association with healthy status and SPO2 levels, when maternal Diseases and weight at birth had a significant association with SPO2 levels at the second stage and health status. Conclusion: From the present study concluded that a high and acceptable diagnostic value of 85% found for SPO2 to detect CHD in neonates in the first 24 hours of life. The factors of maternal diseases and weight at birth had a significant effect in this issue.

Maternal air pollution exposure and neonatal congenital heart disease: A multi-city cross-sectional study in eastern China.

To examine the association between air pollution and neonatal congenital heart disease (CHD), and evaluate the cumulative burden of CHD attributed to above certain level for ambient air pollution exposure. We identified newborns who were diagnosed as CHD by echocardiography in Network Platform for Congenital Heart Disease (NPCHD) from January 2019 to December 2020 in 11 cities eastern China. The exposure lag response relationship between air pollutants (PM2.5, PM10, SO2, NO2, CO, and O3) concentration and CHDs was calculated by the distributed lag nonlinear model (DLNM). We further calculated the cumulative risk ratios (CRRs) of each air pollutant above reference concentrations on CHDs. A total of 5904 CHDs from 983, 523 newborns were enrolled in this study. A 10μg/m3 increase in PM2.5, PM10, SO2, NO2, CO and O3 exposure was associated with an increased risk of higher CHD incident RR=1.025, 95% CI: 1.016-1.038 for PM2.5 in the third trimester, RR=1.001, 95% CI: 1.000-1.002 for PM10 in the third trimester, 1.020, 95%CI: 1.004-1.036 for NO2 in the third trimester, RR=1.001, 95%CI: 1.000-1.002 for O3 in the first trimester, all P value<0.05). Cumulative effect curves of PM2.5, PM10, SO2, NO2, CO, and O3 were observed as sub-linear with a maximum of 1.876 (95%CI:1.220-2.886), 1.973 (95%CI:1.477,2.637), 2.169 (95%CI:1.347-3.493), 2.902 (95%CI:1.859-4.530), 1.398 (95%CI:1.080-1.809), 2.691 (95%CI:1.705-4.248), respectively. Significant associations were observed for air pollutants and CHDs in cities with higher average education years and babies concepted in cold season. Our findings could provide growing evidence regarding the adverse health effects of air pollution on CHD, thereby strengthening the hypothesis that air pollutants have harmful impacts on cardiac development. Further studies are needed to verify the associations.

The potential of genetically engineered pig heart transplantation in infants with complex congenital heart disease.

Despite advances in surgical and medical techniques, complex congenital heart disease in neonates and infants continues to be associated with significant mortality and morbidity. More than 500 infants in the USA are placed on the cardiac transplantation wait-list annually. However, there remains a critical shortage of deceased human donor organs for transplantation with a median wait-time of 4months. Hence, infant mortality on the heart transplant wait-list in the USA is higher than for any other solid organ transplant group. Orthotopic transplantation of a pig heart as a bridge to allotransplantation might offer the best prospect of long-term survival of these patients. In recent years, there have been several advances in genetic engineering of pigs to mitigate the vigorous antibody-mediated rejection of a pig heart transplanted into a nonhuman primate. In this review, we briefly highlight (i) the history of clinical heart xenotransplantation, (ii) current advances and techniques of genetically engineering pigs, (iii) the current status of pig orthotopic cardiac graft survival in nonhuman primates, and (iv) progress toward pursuing clinical trials of cardiac xenotransplantation. Ultimately, we argue that pig heart xenotransplantation should initially be used as a bridge to cardiac allotransplantation in neonates and infants.

Analysis of Congenital Heart Defect in Pakistan

Background and objectives: While the defect has been studied extensively in Pakistan, there have been just a few of research focusing on KPK populations. Because of this, the goal of this study was to identify neonatal congenital heart disease in Pakistani children. Methodology: This cross sectional study was conducted in Sheikh Zayed Medical College during June 2021 to November 2021. Echocardiography was used to diagnose congenital heart disease in 1683 neonates who reported to the outpatient department (OPD) with a variety of ailments. Results: Out of 1683 babies, a total of 303 (or 18%) had a congenital heart condition. It was found that 62.5 per cent of people infected with the virus were men, while 37.5% of them were women. 78 per cent of the cases included infants between the ages of one and three months. Patients described a variety of symptoms they were experiencing. Asthma, pneumonia, and cyanosis were the most prevalent causes of death (4 per cent). The great majority of patients had the cyanotic congenital cardiac disease (98 per cent). (77.9 per cent), followed by PDA (11.5 per cent), ASD (7.9 per cent), TOF (0.9 percent), and aortic stenosis (0.9 per cent) were the most common congenital heart defects observed in the study. (Aortic stenosis was the least common disease) (2.2 per cent). Conclusion: To detect cardiac murmurs in our newborn population, the doctors in our paediatric outpatient clinics must increase their performance. This may result in a significant decrease in sales.

Outcome of Preterm Admissions at the Neonatal Unit of a Tertiary Care Military Hospital of Bangladesh

Introduction: Preterm deliveries contribute to major morbidity and mortality in developing countries. They are a leading cause of admission in neonatal care units. It is a major hindrance to the attainment of the Sustainable Development Goal (SDG)-3 targets given its high contribution to neonatal mortality. Early detection of its risk factors and advances in the management have ensured better survival of preterm births. This study was conducted to determine the prevalence, underlying causes, morbidity patterns and outcome of preterm admissions to a neonatal intensive care unit (NICU) of a tertiary care center in Combined Military Hospital (CMH) Sylhet. Material and Methods: A descriptive study was conducted in CMH Sylhet from July 2018 to June 2020. All live preterm babies delivered at CMH Sylhet during the study period were included. Information obtained included gestational age at birth, gender, cause for preterm birth, problems during admission and outcome. Results: During this period, a total of 662 neonates were admitted out of which 107 (16.2%) were preterm with gestational ages ranging from 27 completed weeks to less than 37 completed weeks with a mean gestational age 33.2 weeks (± 2.7 weeks) and birth weights from 800 - 2600 gm with a mean of 2100 gm (± 700 gm). There were 52 males and 55 females (M: F 0.95). One hundred and thirty three (20.1%) were delivered by normal vaginal delivery while 529 (79.9%) were delivered by Caesarean section. The duration of hospital stay ranged from 1 - 45 days, with a mean duration of 15 days (± 9.2 days). The commonest reason for prematurity was premature rupture of membrane (PROM) (39.3%) followed by gestational diabetes mellitus (GDM) (35.5%), hypertensive disorders in pregnancy (30.8%), multiple pregnancy (29.9%) and inadequate ante natal care (ANC) (20.6%). The commonest morbidity in the patients in the present study was neonatal jaundice (90.7%) followed by respiratory problems (78.5%), sepsis (17.8%) and congenital heart disease (CHD) (15.9%). Case fatality rate for patients with respiratory distress syndrome (7.7%) and sepsis (5.3%) were common. Overall survival rate was 91.6% and was significantly (p &lt;0.001) higher in the moderate to late preterm category compared to the very preterm and extremely preterm births. Conclusion: PROM, GDM, hypertensive disorders in pregnancy, multiple pregnancy and inadequate ante natal care were significantly associated with preterm birth. Neonatal jaundice, respiratory problems, sepsis and CHD were common morbidities observed. Case fatality rate was significant in neonates with respiratory distress syndrome and sepsis and overall survival rate was 91.6%. So, at-risk mothers should receive intensified antenatal care to mitigate preterm birth. J Bangladesh Coll Phys Surg 2022; 40: 39-44