新生児・小児医学

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Congenital Heart Disease in the Newborn and Importance of EarlyIntervention

Kendalem Atalell

Although prenatal diagnostic techniques have improved significantly, the accurate detection and appropriate treatment of newborns with congenital heart disease (CAD) has always been of great interest to pediatricians. Congenital heart malformations range from benign to serious conditions such as: Prompt diagnosis and treatment are necessary if the baby is to survive. Unfortunately, these life-threatening heart conditions may not be apparent early in life and most clinical and physical findings are nonspecific and equivocal, making diagnosis difficult. Decisions require a high suspicion index and keen insight. Many serious malformations can go unnoticed early in life when the patent ductus arteriosus (PDA) is wide open, but can become severe as the PDA contracts hours to days later. It can lead to acidosis/shock/cyanosis or even death. Conduit-dependent congenital heart lesions, which can be classified as conduit-dependent systemic or pulmonary diseases, are physiologically very different from each other and therapeutic strategies should be tailored to the clinical condition and cardiac malformation. Unavoidable early onset is often considered a medical emergency. Differential diagnoses include congenital metabolic disorders, neonatal sepsis, neonatal persistent pulmonary hypertension (PPHN), and other pulmonary diseases. Urgent identification of these atrisk neonates requires timely referral to a pediatric cardiologist, and timely intervention is key to reducing mortality and morbidity. The overview below describes the clinical manifestations, assessment, and treatment of congenital heart defects that manifest early in life.