Maternal malnutrition, tobacco exposure, alcoholism, antenatal infections, unsupervised drug intake in antenatal period, elderly mothers, gestational diabetes, previous child born with congenital heart disease, previous still births are some of the factors. (Source: Getty/Thinkstock)
By Dr Yogesh Sathe
Very few people know that the most common birth defects in humans are Congenital Heart Defects, which means, a child is born with a structural defect in a heart or its blood vessels. It is a shocking reality that Congenital Heart Diseases (CHD) occur in 10 out of every 1,000 live births in the world. In fact, in India alone, 2.4 lakh babies are born every year with CHD, out of 2.4 crore total births per year.
Are all heart ailments in children congenital?
Not really. Though majority of the heart ailments in infants is because of CHD, in our country, as children grow older, rheumatic heart diseases also contribute to a significant proportion of heart ailments. Rarely, functional heart failures secondary to acquired infections are also encountered in children.
What are the top factors that causes congenital heart defects?
CHD is multi factorial and poorly understood. Maternal malnutrition, tobacco exposure, alcoholism, antenatal infections, unsupervised drug intake in antenatal period, elderly mothers, gestational diabetes, previous child born with congenital heart disease, previous still births are some of the factors which puts a mother at risk of giving birth to a child with CHD. Almost 20 per cent of the congenital heart defects have identifiable genetic cause.
Can expecting parents detect CHD when the child is still in the womb?
Yes. Regular antenatal check-up with a fetal anomaly screening by antenatal ultrasound (Fetal Echocardiography) at 16 to 20 weeks of gestation helps in detection of CHDs.
What can be done if CHD is detected during pregnancy?
The mother has to undergo regular antenatal visits without fail and be referred to a tertiary centre where delivery can take place. After delivery, the new born should be referred to a nearby cardiac centre where facilities to address CHDs are available.
Early detection not only helps the family to prepare themselves but also to plan for an optimal course of pregnancy and delivery.
How are heart defects detected in new born babies?
A proper systematic clinical examination helps in detecting CHDs in babies. Pulse oximetry neonatal screening plays a vital role in screening of CHD.
With proper treatment, most of the children born with CHDs are cured and lead normal lives. Children who cannot be cured can be helped with palliative procedures to improve their quality of life. (Source: Getty/Thinkstock)
What are the steps to be followed if CHD is suspected/diagnosed in a new born?
A proper systematic clinical examination is sensitive enough to detect unexplained cyanosis (bluish cast to the skin) and murmurs which warrants further referral for definitive diagnosis.
A detailed cardiac ultrasound (echo) by a trained pediatric cardiologist forms the cornerstone of CHD diagnosis. Further detailed imaging studies like cardiac catheterisation, CT and MRI may be required for complex cases.
What are the commonest signs parents should watch out for?
CHDs can be broadly classified into cyanotic and acyanotic heart diseases. Children with acyanotic heart diseases could have any or all of these -- repeated respiratory tract infections, inadequate weight gain, forehead sweating, feeding difficulties, breathlessness and so on. Cyanotic heart diseases are marked by varying degrees of cyanosis, which is a bluish discolouration of lips and nail beds. Some children could even go into repeated episodes of cyanotic spells, and squatting episodes as they grow older.
Are CHDs treatable?
Definitely. With proper treatment, most of the children born with CHDs are cured and lead normal lives. Children who cannot be cured can be helped with palliative procedures to improve their quality of life and reduce their suffering.
What are the treatment options that parents can opt for?
Open heart surgeries address almost every congenital heart defects today. A small proportion of simple defects can be treated in a cardiac Cath laboratory without open heart surgery.
What is the socio-economic impact of a child crippled with CHD on the family and society?
The impact of CHD is understandably a challenge for the family in terms of expenses incurred and social stigma. But with active initiatives from the Government through Rashtriya Bal Swasthya Karyakram (RBSK) and other similar projects, early detection and referral of children born with CHD has given these families an opportunity to lead a normal life.
(The author is Deputy Director & HOD, Dept of Paediatric Cardiology at the Sri Sathya Sai Sanjeevani International Centre for Child Heart Care & Research.)