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Congenital Heart Disease: What Is The Ideal Time For CHD Diagnosis In Kids?
The ideal stage for the diagnosis of congenital heart disease (CHD) among children is when they are in their fetal form, particularly within 16-20 weeks of pregnancy, said experts on Wednesday. CHD is a condition present from birth which stands as the most prevalent birth defect, affecting eight in every thousand infants who are born annually in India.
Only 10 per cent of those who get diagnosed with CHD receive the required treatment on time, according to doctors at Amrita Hospital, Faridabad.
"During the time between 16-20 weeks (about 4 and a half months) of pregnancy, advanced ultrasound imaging allows healthcare professionals to thoroughly examine the developing heart's structure and function and is able to detect malformation of the heart," said Dr S. Radhakrishnan, HoD, Pediatric Cardiology, Amrita Hospital.
"This period provides parents with the necessary information to make choices about their pregnancy and ensure timely medical intervention if required after the baby is born," he added.
Ventricular septal defect and atrial septal defect (commonly called "hole in the heart") are the most common forms of congenital heart disease, while Tetralogy of Fallot predominates among infants presenting with cyanosis (oxygen deficiency).
According to experts, regular prenatal check-ups with obstetricians equipped with advanced imaging technologies can help identify the fetuses with suspected CHD.
With the help of the latest advancements, the experts said that CHD after birth can be diagnosed using 'Echocardiography' and sometimes may need advanced imaging techniques like CT scan, and MRI.
"CHD diagnosed after birth, the timing of treatment depends on the nature and gravity of the heart issues faced. The critical ones require attention and treatment at birth. Some of the less critical ones may be delayed for months or even a few years," Dr Sushil Azad, Principal Consultant, Pediatric Cardiology, Amrita Hospital, said.
Azad also mentioned that the treatment options vary from surgical to non-surgical therapy depending on the nature of the disease. Treatment options for children with CHD include medication management, catheter-based interventions, and open-heart surgical procedures.
How To Suspect That Your Child May Be Suffering From A Heart Defect?
Children with congenital heart defects Congenital Heart Defects are the most common congenital problem, affecting every 100 live-born babies. In our country, it is not uncommon to see grown-ups diagnosed for the first time with congenital heart defects, and late presentation is primarily due to lack of awareness and health facilities. It is the responsibility of all of us—medical personnel, parents, and society—to work together to increase awareness about the disease so that diagnosis can be made on time and treatment can be offered.
Signs that your child may be suffering from a heart defect? Difficulty in feeding: Feeding difficulty is a common presenting feature in an infant. Parents may complain that the baby gets tired during feeds, takes small, interrupted feeds, and may exhibit excessive sweating. It is not uncommon to switch to bottle feed as the mother becomes very apprehensive.
Poor weight gain: According to Dr. Munesh Tomar, Director Pediatric cardiology and congenital heart diseases, Max Super Speciality Hospital Saket Delhi, "With underlying severe heart disease, there is an increase in caloric demand, but the child is unable to take adequate calories, leading to poor weight gain. Recurrent chest infections also contribute to failure to thrive."
Blueness (cyanosis): The earlier the blueness appears, the more serious the heart defect. Some blue babies present in the emergency room with excessive crying and deepening of cyanosis, known as "cyanotic spells." If there is a history suggestive of a "cyanotic spell," the child needs early intervention.
Tiredness: Early tiredness and inability to keep pace with peers while playing.
Fast heartbeat: Fast heart beat, high blood pressure, frequent chest infections and hospitalizations and sometimes fainting (syncope) could be the presenting symptoms.
What should parents do? If you notice any of the above symptoms, consult a pediatrician. The treating pediatrician may refer the baby to a pediatric cardiologist if there is suspicion of a heart problem. Detailed cardiac evaluation is a must to diagnose the problem and determine the timing of intervention.
Is there any way to detect heart defects before birth? Congenital heart defects can be found before birth by fetal echocardiography, helping families to plan postnatal care and treatment. The ideal time for fetal echocardiography is 18-20 weeks of gestation.
Heart disease in young Indians: Causes, prevention and some critical insights by Dr. Ramakanta Panda
What Is A Congenital Heart Defect?
A congenital heart defect (CHD) occurs when the heart or its blood vessels don't develop in a fetus properly before birth. This defect usually starts to develop early in pregnancy. There are many types of CHDs, which can range in severity from mild issues like holes between heart chambers to more complex problems, such as the absence of one or more heart chambers or valves. When a baby is born, a healthcare provider will likely run tests to check the heart function and diagnose a CHD.
Having a CHD can increase the risk of developing several other conditions, such as high blood pressure in the lungs (called pulmonary hypertension), irregular heartbeats, an infection of the heart's inner lining (known as infective endocarditis), congestive heart failure, and some kidney and liver diseases.
Nearly 1% of babies born each year (which is about 40,000 babies annually) have a congenital heart defect. Most children with mild defects grow up to live normal or nearly normal lives, although they may have some limitations in physical activities. Babies with more complex heart defects may experience more significant physical limitations, developmental days, or learning disabilities. But treatment can help a child live well throughout their life.
The symptoms of CHDs can vary greatly, depending on the specific defect that you or your baby and the severity of the condition. Some common signs of a CHD include: Cyanosis, or a blueish tint in the skin, lips, or fingernails Fatigue or sleepiness during feedings Poor blood flow Rapid or labored breathing Heart murmur (unusual sound between heartbeats) Pulmonary edema (fluid buildup in the lungs) Enlarged liver Children born with CHDs often face unique challenges, including being smaller in size compared to their peers. They may also experience developmental delays in certain areas, like speech and language. A child with a CHD may also be at an increased risk of attention deficit hyperactivity disorder (ADHD). CHDs are present at birth and often have unclear causes. However, researchers do know that they can be linked to genetic changes in a baby, which might be inherited from their parents. The severity of these defects can differ greatly, meaning that children might experience health problems that are either more or less severe than those of their parents. CHDs in a baby can also result from exposures the birth parent had during pregnancy, like having certain infections or taking medications. It's important to note that death rates from CHDs have decreased overall. But there are notable differences among people from certain racial backgrounds. Studies show that the cause of death from a CHD is higher in Black and Hispanic children under four years of age compared to white children. For children between 5 and 17 years old, these rates have significantly dropped, but Black children still experience a higher risk of death. Researchers are still working to understand the racial disparities in CHD cases. Some researchers suggest that systemic issues like access to quality care, availability of healthcare providers who specialize in CHD, and proper health insurance coverage play a role. Experts also suspect that racism in the healthcare system and income inequality are potential concerns. But more research is still needed to understand why Black and Hispanic children with a CHD experience a higher risk of death. A healthcare provider can diagnose a CHD before birth through a fetal echocardiogram—a type of ultrasound that takes detailed images of the to reveal any defects or problems in the heart. After a baby is born, your provider will also check blood oxygen levels to assess the newborn's heart function. If oxygen levels run low, more testing is needed. If your baby needs additional testing, your healthcare provider may order one or more of the following tests: Electrocardiogram (ECG/EKG): Checks for problems with the heart's rhythm and can detect issues like unusually large heart chambers or changes in the heart's position Chest X-ray: Shows heart size and fluid in the lungs that can point out specific signs of certain CHDs Two-dimensional echocardiography: Uses sound waves to create images of the heart and measures blood flow through the heart to determine any issues with the heart's chambers, valves, or structure If you or your baby have a congenital heart defect, your primary care provider will often work with a cardiologist (a doctor who specializes in heart conditions) to guide treatment and ongoing care. It's worth noting that children and adults with CHD may also be at risk of developing other heart conditions like congestive heart failure, heart rhythm problems, and pulmonary hypertension. So alongside treatment for a CHD, they may also need treatment for related heart conditions. Treatment and care for CHDs can include a variety of approaches, such as: A cardiac catheterization procedure, which uses a thin tube to take images of the heart's structure and allows for less invasive procedures to fix heart valve or blood vessel problems Surgery to repair the structure of the heart and blood vessels Heart transplant if your heart isn't functioning properly even with other treatments Your healthcare team will offer guidance on how to prepare for surgery. In the days leading up to the surgery, your provider may set up a hospital tour so you or your child have an idea of where to go and what to expect. You and your family may also receive nutritional advice about what to eat (and not eat) before surgery. Your provider should also tell you what you can expect about the recovery after having heart surgery and how often you need to have follow-up appointments. Because a CHD doesn't have a clear cause, experts don't have enough information to understand what can prevent a heart defect. But, the National Heart, Lung, and Blood Institute recommends talking to your healthcare provider or genetic counselor about what medications you should avoid during pregnancy, how to keep underlying health conditions (like diabetes) in control, and which lifestyle changes you should be making (such as stopping smoking and drinking alcohol). People with a heart defect may experience additional health issues related to their heart condition as time progresses. The likelihood and nature of these problems can vary based on the type of heart defect they have, the number of defects present, and the severity of their condition. Common conditions related to CHD include: Infective endocarditis (an infection that occurs when bacteria enter the bloodstream in your heart's lining or valve) Arrhythmia (irregular heartbeat) Pulmonary hypertension (high blood pressure in the lungs) Liver diseases (conditions such as hepatitis or cirrhosis) As adults with CHDs grow older, they are also more vulnerable to other common conditions that affect other adults, such as diabetes and obesity. For some, managing a heart defect may involve regular visits to a cardiologist and consistent monitoring. In cases where the defect is more serious, surgical procedures might be needed. It's important to remember that a heart defect can change over time, so ongoing medical care may be necessary, even if the defect was treated in childhood. For personalized information on how to live well with your CHD, it's best to consult with your provider.Thanks for your feedback!
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