Clinical profile and outcome of congenital cyanotic heart disease in neonatal period: a retrospective study

Abstract

Background: Congenital Cyanotic Heart Disease (CCHD) is under reported during neonatal period and mortality rate is high in India. Aims and objectives of the study determine clinical presentation, maternal and neonatal risk factors and outcome of CCHD during neonatal period.Methods: A retrospective study conducted over 15-month period during March 2017 to June 2018 in a tertiary out born NICU. Neonates with echocardiographically confirmed case of structurally abnormal heart disease were analyzed.Results: Among 106 CCHD neonates, 60% neonates were asymptomatic, 22% had persistent cyanosis and 19% had tachypneic at birth. Cyanosis (35%) and tachypnea (30%) were common initial presentation in postnatal period. 22% neonates were readmitted with initial clinical symptom after discharge from birthing centre. CCHD were more common in male and term neonate, 34% were small for age, median age at admission and discharge were 5days (2-12) and 5 days (2.7-9.2) days respectively. Nineteen percent neonates had fetal distress and 6% neonates required aggressive resuscitation at birth. First trimester abortion (16%), maternal diabetes (10%) and hypothyroidism (7%) were common maternal risk factor. Nearly 20% neonates were diagnosed at referring hospital and 4.7% were transported with PGE1 during transport. TGA (17%) was most common lesion noted followed by pulmonary atresia (10%). Fourteen percent neonates died during the neonatal period. Disease specific death rate was highest for Single ventricle (42%) followed by TGA with IVS (37.5%) and aortic arch anomaly (28.5%) in this study.Conclusions: Early diagnosis and management may improve the survival in CCHD neonates.

Emergency Department Presentation and Outcome of Children With Cyanotic Congenital Heart Diseases

“…Increasing cyanosis was the most common presenting symptom followed by fever and respiratory distress, which aligns with findings reported by Al-Hamash [12] and Pradhan et al [13]. Respiratory distress and fever are common presenting symptoms in studies that include cyanotic and acyanotic CHDs [14].…”

Spectrum of cyanotic congenital heart disease in full term neonates attending paediatric cardiology clinic of a Tertiary Cardiac Care Centre.

“…17 TGA was the most common CCHD in neonatal period (27.9%) in a study conducted in Srinagar. 18 In another study conducted in Chennai 19 , TGA was the most common CCHD noted in 33.9% of cyanotic congenital heart disease neonates. Similarly a study by Lynch A et al 20 showed that TGA was the most common cyanotic CHD in prenatal as well as post natal period.…”

“…17 In a study carried out in Tamil Nadu, pulmonary atresia was the second most common cyanotic CHD after TGA. 19 In another study done in Aga Khan University Hospital 16 , TOF with its variants was the most common CHD as pulmonary atresia was not considered as a separate entity. Pulmonary atresia is the third commonest cyanotic congenital defect with a frequency of 18.4% in our study.…”