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  Children's Health

May 2012

Oh Baby! So Stressed!

Dr Vishal Changela
 
The health of a child is largely dependent on the health of the mother. One of the commonest health issues, which arises at childbirth, is that of Congenital Heart Defects (CHD). Ten out of every 1,000 children suffer from CHD. Apart from CHD, difficult pregnancies too have long-term effects on the health of a child.

Pregnancy Issues That Affect A Child’s Heart

  • When the mother is diabetic: The child is at risk for thickening of the heart walls and low blood sugar. Low sugar affects brain growth and maturation.
  • When the mother has a history of congenital heart disease (CHD) or a previous child with CHD: The newborn too is at high risk of CHD.
  • The mother with infections like “rubella”: The child is susceptible to PDA (Patent ductus arteriosus) a persistent communication between the aorta and pulmonary artery caused by malfunction of foetal ducts.
  • Women undergoing radiation exposure during pregnancy (like X-ray or CT scan), women on medication with drugs like anticonvulsion drugs, high dose vitamins - Vitamin A or D: High risk of CHD in the child.
Delivery Related Factors And The Adverse Cardiac Effect In The Newborn
Any woman who is ill is at risk of difficult delivery or labour. Any difficult delivery can lead to delayed baby’s cry (called birth asphyxia) or stool getting aspirated into the lungs of the infant (known as Meconium Aspiration Syndrome). These complications deprive the infant of sufficient oxygen. Consequently, the baby’s heart gets stressed out. Thus, the heart muscles may become weak (ventricular dysfunction) or develop high lung pressure (PPHN-Persistent Pulmonary Hypertension of Newborn).
These infants require close cardiac monitoring and treatment in Neonatal Intensive Care Units. Consultation and Echocardiography from a paediatric cardiologist is a vital part of clinical care for these tiny patients.

Lack Of Awareness
Awareness concerning the effects of a difficult pregnancy on the newborn is low. Parents are often unable to recognise the symptoms and even doctors do not notice the symptoms at times.

Care For Ailing Newborns
Any sick child, who requires care in the NICU, is at risk of long-term neurodevelopment issues too. These children should be evaluated by a paediatric neurologist. Hearing and vision assessment is also part of the evaluation. They are kept on an “Early Stimulation Programme” which helps them achieve good neurodevelopment.

Any child, who undergoes heart surgery, should also get evaluated for neurodevelopmental aspects.

Any child with genetic problem is a “Syndromic Baby”. Such children have special features on the various body parts. They are prone to CHD as well. For example, 40 per cent of babies with Down’s Syndrome have CHD. All these children should undergo a check-up for Paediatric Cardiac issues. They are also prone to multisystem problems in their body. Pregnant mothers should be screened for this problem.

Early diagnosis and management is the most important aspect.
The Role Of The Neonatologist
The neonatologist is the key person in the care for the newborn. All sick neonates should be treated by a neonatologist, in specially equipped neonatal intensive care units. The best care is possible with a round-theclock team of expert doctors, trained nurses. In an NICU, the equipment is highly sophisticated and their operation too needs expertise. Close observation and attention to minute details are a must.
Dr Vishal Changela is Interventional Paediatric Cardiologist, Apollo Hospitals Intl Ltd, Ahmedabad.

    
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