Neonatal heart examination - what does it look like and when is it needed?

Neonatal heart examination - what does it look like and when is it needed?

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Congenital heart disease are one of the most frequently detected abnormalities in newborns. Some of them may still be diagnosed during intrauterine life using ultrasound (such a fetal cardiac echocardiography should be performed routinely between 18 and 22 weeks of pregnancy). However, due to slightly different mechanisms of fetal circulation, the vast majority of heart defects and diseases do not manifest themselves until after birth. For this reason, newly born children place great emphasis on the study and monitoring of cardiovascular and associated respiratory function. Because this is a very important issue for young parents, we will try to describe all the most important information about the newborn's heart examination, so that after reading the article each parent knows and understands the purpose of such behavior, and thus, approaches it with greater calmness.

What is the heart test of newborns?

The first heart examination of a newly born baby is already performed in the delivery room during the overall assessment of the newborn's condition on the APGAR scale. The doctor then assesses, among others newborn heart rate, which is much faster than in older children or adults, and is over 100 heart beats per minute.

If the child is in a good general condition, it is left on the mother's or father's chest (in the case of delivery by Caesarean section) and subsequent tests are only carried out later.

On the limbs of newborns, pulse oximeters are temporarily put on - new devices that measure oxygen saturation, or oxygenation, non-invasively. Already at this stage, irregularities in the results of saturation or its differences between limbs may suggest existing in the circulatory and respiratory system.

In the first day of life, the newborn is examined and examined by a neonatologist or pediatrician. During the examination by a specialist, he pays special attention to skin color, muscle tone, and breathing effort, which at first glance may indicate some irregularity. Then goes to auscultation of the heart, when he pays special attention to hearing the heart - on its regularity and frequency, and on the presence of murmurs which may be evidence of a congenital heart defect. If you hear this murmur or other irregularity, you must perform it UKG tests.

What is the ultrasound scan, the echo of a newborn baby?

The UKG examination, also known as the ECHO of the heart, involves thorough examination and anatomical and functional assessment of the baby's heart using ultrasound. It is completely Non-invasive and just like in the case of ultrasound of the abdomen, so here the examination is possible thanks to the use of a special head and assessment of the heart in various projections. It allows you to confirm or exclude both irregularities in terms of structure and function of the elements of the heart and vessels. Disadvantages that can be diagnosed by UKG include

  • VSD - ventricular septal defect
  • ASD - atrial septal defect
  • Heart valve regurgitation
  • Narrowing of the ventricular outflow tract

What is transesophageal ultrasound?

Sometimes the ECHO supplementary heart test is transesophageal ultrasound (TEE). It is performed to better visualize the atria and vessels departing from the aorta. The image is obtained in this case using a small probe equipped with a tiny ultrasound transducer, inserted into the esophagus of a small patient. Compared with ordinary UKG, this examination must take place with the participation of an anesthesiologist.

In addition to heart disease associated with birth defects, they can often occur in babies Heart arythmia. Then it is extremely helpful to connect the newborn to cardio-monitor, which continuously monitors heart rate and heart rate, and when connected pulse oximeter also saturation or oxygenation of the baby's blood.

Irregularities in the study and what's next?

If any irregularities were found in the performed tests, then depending on the defect or disease detected, further steps should be taken. In case of revealing an abnormality caused by a heart defect are necessary consultations with a pediatric cardiologist and often cardiac surgery.

Depending on the type of the defect found and the child's general condition, the medical consulium determines the best treatment method for him and the time when any surgery will be performed. One should be aware of that many irregularities are so harmless that the child can wait without waiting until they reach the appropriate age for the surgery, but some of them may require urgent intervention. In such cases, the decision about the surgery is difficult for parents, but also necessary for the baby's survival.

If the newborn suffers from cardiac arrhythmias, doctors need to diagnose them carefully and look for the reasons for this. In this case, you will also need a cardiological consultation during which further diagnostic and therapeutic steps will be planned. Sometimes cardiac arrhythmias are transient and may be associated e.g. with abnormal blood electrolyte ion values, while sometimes they will require constant pharmacological treatment.

What should worry a parent after leaving the hospital?

Some defects or diseases of the heart and circulatory system may not manifest themselves until they are discharged home, so the parent should pay close attention to the alarm symptoms. The most important of them are:

  • Respiratory effort - moaning or contracting of the tummy and skin between the ribs indicating difficulty in breathing.
  • Bruising - initially noticeable on the lips, mouth and fingers.
  • Cold extremity.
  • Anxiety and unceasing crying.
  • Difficulties feeding and growing on weight.

If you notice any of these symptoms in your child, you should immediately consult a doctor as they may herald a life-threatening condition.

Why do irregularities sometimes become apparent only after being released?

This is due to the fact that in utero life there are d in the baby's heartknows the structures that are very important to him, which close at birth: this is the oval opening and Botalla's ductus arteriosus.

In the case of heart defects in which the patency of any of these structures ensures the proper functioning of the circulatory system, their closure causes disturbing symptoms. Although both structures usually close to about 48-72 hours after birth (and thus usually still in hospital), in some cases their closure may take much longer and this is the reason why some of the defects and heart diseases are revealed only after the newborn is discharged home.

Widely run in Poland cardiological screening in newborns is designed to detect possible existing irregularities in the circulatory system and respond to them accordingly.

We hope that after reading this article, young parents (and not only) will be somewhat more calm about the subject of performing a number of tests in a child. Irregularities detected in this way can be properly corrected or treated, which in many cases reduces the possibility of developing serious complications and gives a chance for further survival.

Sources:Pediatrics volumes 1 and 2 edited by Wanda Kawalec.Heart defects in children for pediatricians and family doctors by Bożena Werner. -