Clinical Profile, Pattern of Presentation and Short Term Outcome of Cyanotic Congenital Heart Disease in Neonates

Abstract

Background: Cyanotic heart disease refers to a group of many different heart defects that are present at birth (congenital) that results in a low blood oxygen level, many of which are life threatening in neonatal period necessitating early diagnosis and prompt treatment.Thus, by early intervention for critical cyanotic congenital heart diseases in neonatal period or early infancy, children can survive beyond the pediatric age.Aim of the study: To determine the clinical profile and pattern of presentation and short term outcome of cyanotic congenital heart disease in neonates.Methods and Materials: An observational type of cross-sectional study was conducted in the Department of Pediatric Cardiology of Dhaka Shishu hospital between the study period of July to December 2019 where total 74 newborn with cyanosis were recruited from outpatient and inpatient departments .Cyanotic congenital heart disease was diagnosed with the help of clinical examination and investigations finding and associated risk factor and treatment and short term outcome was documented.Results: Among the 74 neonates 58 (78%) were male and 16(22%) were female and male : female ratio was 3.6 :1.Age of presentation of majority of patient (n=36) was 16-28 days whereas only 3 patient presented in between 0-2 days.The neonates mainly had Transposition of Great Arteries (TGA) (n=22), Tetralogy of Fallot (TOF) (n=12),Tricuspid Atresia(n=7), DORV(n=7), Total Anomalous Pulmonary Venous Return(n=5), Hypoplastic Left Heart Syndrome(n=3).The median age of presentation of common cyanotic congenital heart defects like TGA, TOF, Tricuspid Atresia, DORV are 12-15 days.Median age of presentation for TAPVC was highest that is 23 days and Ebstein anomaly was lowest that is 8 days.In this study all of the study neonates (n=74) had cyanosis.Out of 74 patient 69(93%) had tacyhpnea, 61(82%) had tachycardia, 38(51%) had murmur, 26(35%) had hepatomegaly.Crepitation, rhonchi and oedema were found respectively 34(45%), 24(32%) and 19(25%) patients.2 patient (2.7%) presented with shock.In this study it has been seen that majority of the patient that is 54 (72%) were term neonate.Family history of CHD were found in 9 (12%) of patient and consanguinity was found in 31 (41%) of patient.Other risk factors found were maternal diabetes mellitus in 19 (26%) patients, maternal hypertension in 28 (37%) patients, infection during pregnancy in 15 (20%) patient and parental smoking in 39 (53%) patients In this study 9 (12%) patient received prostaglandin, 21 (28%) required use of Ionotrops, antifailure drugs were used in 36 (48%) patients and emergency procedures were performed in 13 (17%) patients.Regarding outcome, 11 (14%) patient required ventilatory support, 19 (25%) had an ICU stay and death occurred in 6 (8%) patients.Conclusion: Cyanotic congenital heart disease in neonates is often undiagnosed which is main the cause of high case fatality.Development of neonatal screening program for early detection of such cases and prompt measure can surely save life of many newborns.Therefore gathering knowledge about the clinical profile and pattern of presentation of cyanotic congenital heartdisease in neonates in our country's perspective will definitely help to avoid complication, reduce mortality and improve quality of life of the newborns.