Heart Day

[Guest Babyheart]

Happy Valentines Day Everybody! Remember today is also Congenital Heart Defect Awareness Day.

About 40,000 infants are born with heart defects each year in the United States. The defect may be so slight that the baby appears healthy for many years after birth, or so severe that its life is in immediate danger. An infant born with even a severe defect can look normal for the first 2 or 3 days as the ductus arteriosus is widely open to supply blood flow to the body and the infant may even be discharged from hospital. As the ductus arteriosus closes, which it typically will in most infants in the first hours or days of life, the perfusion to the body is seriously diminished and shock rapidly ensues.

Cyanosis, therefore, may be the first clue to the presence of a serious underlying cardiac condition.

Respiratory distress is often present because the lungs will tend to receive an excessively large amount of blood flow.

Lower-than-normal oxygen saturations.

The pulses may be very weak in all extremities on examination depending on flow through the ductus arteriosus. Lethargy, poor feeding, and worsening respiratory distress may be seen as the ductus arteriosus closes. Ultimately, severe shock resulting in seizures, renal failure, liver failure, and worsening cardiac function may develop. Whether these problems are reversible depends on both the severity and the duration of shock.

What can you do?

Continue your education - know what is not normal.

Be alert and look for signs such as

* a rapid heartbeat & breathing difficulties, especially during exercise or in infants, during feeding.

*Swelling of the legs or abdomen or around the eyes also may occur.

*Cyanosis. Cyanosis increases with crying.

*Cold extremities.

*Enlarged liver

* Tiring easily.

*Pale skin/cool skin/ or sweaty, clammy skin (each child may exhibit different signs)

* Shortness of breath and fainting often worsen when the child exerts himself. Some youngsters may squat frequently to ease their shortness of breath.

Normal O2 saturations for infants with CHDs may range from the 60s to 90s. Especially between surgeries.

In some CHDs (HLHS being one) even though the infant may have low oxygen saturations, supplemental oxygen is avoided since it tends to promote more blood flow to the lungs which may steal blood flow from the body and place excessive demands on the already stressed single right ventricle.

FOR MEDICS

The pulmonary vascular resistance of a newborn is slightly less than the systemic vascular resistance and begins to fall soon after birth. In the patient with hypoplastic left heart syndrome, decreased pulmonary vascular resistance causes increased pulmonary blood flow and an undesirable obligatory decrease in systemic blood flow. Increased alveolar oxygen decreases pulmonary vascular resistance, leading to increased pulmonary blood flow. Therefore, most infants should remain in room air with acceptable oxygen saturation (pulse oximeter) in the low 70s. An exceptional circumstance would be in the infant with severe hypoxemia caused by pulmonary venous hypertension.