TO STUDY THE SPECTRUM OF NEONATAL CONGENITAL CARDIAC DISORDERS

of presentation of newborns with cyanotic CHD acyanotic CHD. of neonates with acyanotic CHD 190 (56.7%) presented the of cyanotic and critical CHD 44 (32.4%) presented 1st


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Congenital heart diseases are not fixed anatomic defects that appear at birth, but are instead a dynamic group of anomalies that originate in fetal life and change considerably during the postnatal development3. The incidence of moderate-to-severe structural CHD in live born infant is 6-8 per 1000 live births4.
The diagnosis is established by 1 week of age in 40%-50% of patients. CHD is considered as one of the leading causes of neonatal mortality5.
The prevalence of congenital heart dellfects in neonates has been studied thoroughly and is usually reported to be 5-8/1000 live births6, 5,7. Asian race is found to be more affected than non-Asian race due to high rate of consanguineous marriages8.. Nearly 1/3rd of the congenital heart diseases (CHD) are critical requiring interventions in the first year of life9. CHDs contribute to infant mortality significantly as 7% of the neonatal deaths are due to congenital malformations, 25% of which are cardiovascular9.
In India, 10% of the present infant mortality may be accounted for by Congenital Heart Disease as reported by Saxena et al10. The incidence of severe CHD requiring expert cardiologic care is around 2.5-3/1000 live births11. The neonates with CHD may present with, feeding difficulty, fast breathing, cyanosis, cardiovascular collapse, and congestive heart failure or combination of these presentations. Pure versions of specific defects may present in some patients, but many neonates have various combinations of defects12.

Methods And Study Design:-
The study was conducted in the Postgraduate Department of Pediatrics, GB Pant Children's Hospital an associated hospital of Government Medical College, Srinagar. The hospital has a catchment area of both rural and urban populations and is the referral tertiary care hospital of valley.

All children
were screened through proper history and examination followed by ancillary tests like ABG, SpO2, ECG and Chest X-ray and the diagnosis was confirmed by Echocardiography (2D Echocardiography). On this basis the profile of various congenital heart defects were studied.

Study Design:
It was an observational prospective study carried out in the Neonatology Section, Department of Pediatrics, GB Panth Childrens hospital Srinagar from November 2017 to August 2019.

Inclusion Criteria
All neonates suspected of congenital heart disease presenting to Pediatric OPD/IPD/Nursery, on the basis of history and clinical examination were included. A suspected case was defined as 1.
Any child with SpO 2 <93% at room air/or visible cyanosis 2.
Abnormal heart sounds Abnormal Blood Pressure 1. Differential Peripheral pulses 2.
Abnormal chest X-Ray Exclusion Criteria 1. All preterm newborns with PDA and PFO. 2. Children more than one month of age.
Details of all neonates having CHD diagnosed by echocardiography were noted in the preformed proforma. Echocardiography was done by a single pediatric cardiologist on SIEMENS ACUSON SC2000 using M-mode, twodimensional color Doppler cardiac imaging. 183

Statistical Methods:
The recorded data was compiled and entered in a spreadsheet (Microsoft Excel) and then exported to data editor of SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA). The data was summarized as frequencies and percentages.
Graphically the data was presented by bar and pie diagrams. Chi-square test was employed to compare various parameters between cyanotic and acyanotic heart disease. A P-value of 0.05 was considered statistically significant.

Results and Observation:-
During the two year study, 471 neonates were diagnosed with congenital heart disease in which 335 (71.1%) were acyanotic and 136 (28.9%) were cyanotic. Males and females comprised of 253 and 218 respectively with a male to female ratio of 1    In our study males were more than females with 253 (53.7%) and 218 (46.3%) with a male to female ratio of 1.2:1.   In our study the most common CHD was ventricular septal defect (VSD) 103 (32.5%) followed by atrial septal defect (ASD) 98 (20.8%) and PDA 47 (10.0%). 185

Discussion:-
According to Mitchell et al's definition, congenital heart disease is a gross structural malformation of the heart or great intrathoracic vessels with a real or potential functional importance. 1 Therefore this definition excludes anomalies such as bicuspid aortic valve without valve dysfunction, mitral valve prolapse, persistent left superior vena cava, anomalous origin of the left subclavian artery, mild valve regurgitation, and functional alterations without a structural component. This definition was adopted in this study.
Congenital heart disease (CHD) has already been known as an important cause of significant morbidity and mortality in the neonatal period. The neonatal unit is the best place for screening and diagnosis of CHD 18 .
During the 2-year study, 471 neonates were diagnosed with CHD of which 335 (71.1%) were acyanotic CHD and 136 (28.9%) were cyanotic CHD, which was comparable to a study by Shah GS et al (2008) 19 14 in which the mean age of presentation of neonates with CHD was 5 days and all had cyanotic type of CHD. Hence, most of the critical and cyanotic CHD present in the first week of life indicating that early detection of these neonates is critical for their survival.
In our study, the ratio of male-to-female was 1.2:1. This is comparable to many studies viz. Shah GS et al (2008) 19 in Nepal wherein the male-to-female ratio was 1.5:1. Humayun KN et al (2008) 14 in Pakistan wherein male-tofemale ratio was 1.7:1. The male preponderance in CHD was seen in majority of the studies conducted worldwide.
In our patients d-TGA was the most frequent type of cyanotic CHD with a frequency of 39 (8.  17 the most common types of cyanotic CHD were TOF followed by d-TGA. This difference can be because of the inclusion of only neonates in our study, while other studies included older children and usually TOF presents after a few months of life. Higher incidence of complex CHD in our study can be due to high rate of consanguineous marriage in this part of India. Besides, it also reveals low rate of antenatal diagnosis of complex CHD. There is less awareness about fetal echocardiography. Among acyanotic CHD, the most common CHD is VSD in 153 (32.5%), followed by ASD in 98 (20.8%) and PDA in 47 (10%). Our results are comparable to study by Hussain S et al (2013) 17 , Khalil A et al (1994) 13 noted VSD and PDA were the most common lesions found in 34.8% and 18.6%, respectively. The lower rates of PDA in our study are due to inclusion of only hemodynamically significant PDA in our study with left atrium:aorta ratio of 1.2:1.

Conclusion:-
Congenital heart disease (CHD) is a common congenital disorder of the neonatal population. Early diagnosis and timely management are key factors for optimal outcome of this problem. It can be easily diagnosed by detailed and careful clinical examination by trained medical personnel, pulse oxymetry and echocardiography. Exercising high index of suspicion during the neonatal examination can significantly change the outcome of CHD.