Newborns are sometimes born with conditions, one of which is congenital heart disease. It is not an uncommon condition and can vary in severity. Sometimes congenital heart defects can be simple without requiring any treatment. However, sometimes it can be more complex, requiring one or several surgeries over several years.

What is a Congenital Heart Defect?

Problems with the structure of the heart are known as congenital heart defects. Since such defects are present at birth, they are known as congenital. They happen when the baby’s heart does not develop normally during pregnancy. They are the most common type of birth defect found in infants.

These defects change the way the heart pumps blood resulting in slow flow of blood, movement of blood in the wrong way or blocking the flow completely. Sometimes, they can be mild and do not need any treatment at all. However, sometimes congenital heart diseases can be more severe requiring one or several surgeries during a child’s life. Sometimes a child may need surgery in the first year of their life as well.

Congenital heart defects can be of various types, based on which part of the heart is affected. The most common types are:

• Septal defects when there is a hole between the two chambers of the heart.
• When the aorta, the main large artery of the body is narrower than normal, it is known as coarctation of the aorta.
• Pulmonary valve stenosis is where the valve which controls the flow of blood out of the lower chamber of the heart to the lungs, the pulmonary valve, is narrower than normal.
• A part of the heart does not develop properly leading to an underdeveloped heart. This condition makes it difficult for the heart to pump sufficient blood around the lungs and body.
• Transposition of the great arteries where the aortic and pulmonary valve and the connecting arteries have swapped positions.

Symptoms of Congenital Heart Diseases

Serious congenital heart diseases are usually found at birth or during the first few months of a child’s life. Common symptoms of congenital heart diseases include:

• Blue or pale grey lips, fingernails or tongue. The changes may be harder to see based on the colour of the skin.
• Swelling in the belly, legs or areas around the eyes.
• Rapid and heavy breathing.
• Shortness of breath, especially during feedings.
• Poor weight gain

However, congenital heart diseases which are less serious may be difficult to diagnose until the child is older. Symptoms of these kinds of heart diseases are:

• Feeling tired easily or shortness of breath during activity or exercise.
• Fainting during different kinds of activity or exercise.
• Swelling in the feet, ankles and hands.

If you notice any of the above symptoms in your child, please consult a doctor immediately.

Causes of Congenital Heart Defects in Children

To understand the causes, it is important to first understand how the heart works.

A heart typically has four chambers, two on the left and two on the right. The two upper chambers are known as atria and the two lower chambers are known as ventricles. The right and left sides have different tasks. The right side moves blood to the lungs through the lung arteries known as pulmonary arteries. This blood transports oxygen to the lungs. The blood then moves to the left side of the heart through the pulmonary veins. The left side pumps the blood through the body’s main artery aorta to the rest of the body.

Risk Factors

So which babies are more likely to develop a congenital heart defect? Several factors contribute to the chance of a child developing a congenital heart defect such as:

The Mother’s Health Before and During Pregnancy

Having diabetes or developing the condition in the first three months of pregnancy increases the risk. Hence, monitoring blood sugar levels throughout pregnancy is very crucial.

Phenylketonuria is a rare inherited disorder that affects the body’s usage of protein in foods. Eating a low-protein diet before getting pregnant helps reduce the risk of the baby developing the condition.

Having Rubella or German measles during pregnancy can change the baby’s heart development. This is why doctors conduct blood tests during pregnancy to determine whether the mother is immune to rubella. For those who are not, vaccines are available.

Substance Usage during Pregnancy

The mother’s contact with certain substances poses risks to the baby developing this condition. Smoking or exposure to second-hand smoke increases the risk. Certain medications such as the usage of ACE inhibitors during high blood pressure or retinoic acids for acne also increase the risk.

Inform the doctor in case you are exposed to any of the above.

Genetics and Family History

The good news is congenital heart defects do not run in families. However, if you or your partner has a congenital heart disease or you already have a child with the same defect, the chances of your baby developing it increases.

How to Reduce the Risk of Congenital Heart Defects?

If you are pregnant or trying to get pregnant, one of the key things to know is how to reduce the risk that your child may be diagnosed with this defect.

Here are a few things you can do:

• Get vaccinated against flu and rubella.
• Avoid drinking alcohol during pregnancy.
• Avoid taking any medication without consulting your doctor. This includes all types of over-the-counter medication as well as herbal medications.
• Taking folic acid during pregnancy reduces the risk of congenital heart disease and several other types of birth defects in your baby. Speak to your doctor about the dosage you need.
• If you have diabetes or develop it during pregnancy, ensure it is controlled.
• Avoid exposure to organic solvents including pain thinners, nail polish remover and dry cleaning agents.

Diagnosis of Congenital Heart Defects

Congenital heart defects are diagnosed through various kinds of tests.

• Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart to check how the heart is beating. During this test, sticky patches with sensors known as electrodes are attached to the chest and sometimes to the legs and arms. The wires connect to the computer which displays and prints results.
• Pulse oximetry: A sensor is placed on the fingertip to record the amount of oxygen in the blood. Less oxygen may indicate a heart or lung problem.
• Echocardiogram: This test uses sound waves to create images of the heart while it is functioning. It reflects how the blood moves through the heart and the heart valves. Sometimes this test is done before the baby is born, known as a fetal echocardiogram.
• Cardiac catheterization: During this test, a doctor inserts a flexible thin tube called a catheter into a blood vessel in the groin area and guides it to the heart. This test provides detailed information on the blood flow and shows how the heart works. Some heart treatments are done during cardiac catheterization too.
• Chest X-ray: The condition of the heart and lungs is reflected in a chest X-ray. It reveals whether the heart is enlarged or whether the lungs contain extra blood. Both of these can indicate heart failure.
• Cardiac MRI: A heart MRI uses magnetic fields and radio waves to draw detailed images of the heart. This test creates a 3D picture of the heart and provides an accurate measurement of heart chambers. It is done to diagnose and evaluate congenital heart defects in teenagers and adults.

Treatment of Congenital Heart Diseases

Treatment depends on the specific type of defect and how severe it is. The less serious congenital heart diseases may not have long-term effects on the child if they are untreated. Some defects, such as a small hole in the heart, may close as the child grows up. However, serious congenital heart defects need to be treated seriously. The treatment path includes:

Medications

Medications are used to address symptoms and avoid complications. The most commonly used medication options are:

• Heart rhythm drugs commonly known as antiarrhythmics, are used to control irregular heartbeats.
• Blood pressure medications are used to manage blood pressure. Common examples of these medicines are angiotensin 2 receptor blockers (ARBs), beta-blockers and angiotensin-converting enzyme (ACE) inhibitors.
• Diuretics, also known as water pills, remove fluid from the body. They can lower the strain on the heart.

Surgery

Your doctor may suggest surgery to treat serious congenital heart defects. The surgery options include:

• Cardiac Catheterization: Some types of defects can be repaired using flexible thin tubes known as catheters. These treatments enable doctors to fix the issue without opening the heart.
• Heart Surgery: Doctors suggest minimally invasive heart surgery or open-heart surgery to repair a congenital heart defect. The type of surgery used depends on the kind of defect in the heart.
• Heart Transplant: Some serious congenital heart defects cannot be fixed requiring a heart transplant.
• Fetal Cardiac Intervention: Sometimes when a congenital heart defect is diagnosed before the birth of a child, it can be fixed through fetal cardiac intervention. It can not only help in fixing a defect but can also prevent complications as the baby grows during pregnancy. This procedure is rarely done and can only be done in specific situations. Some children suffering from serious congenital heart diseases may need surgeries throughout their lives. They may also need lifelong follow-up and care and go for regular health checkups with a cardiologist.

Taking Care of a Baby with Congenital Heart Defect

Knowing that your child has congenital heart disease can be a difficult thing to handle, however, it is most important to be strong. The entire family have to work together to make life easier for the baby and yourselves.

It is most important to know how to take care of your baby, and in most ways, you will do so the same way you will take care of a baby without a heart defect. Your child needs lots of love and attention. Hold your baby, play with them and talk to your baby. This closeness is important both for you and your child.

Your baby may get tired easily, so breastfeeding can be a challenge. However, breast milk is the best food for your child as it protects them from infections and an infection can make your baby’s heart issue worse. Talk to your doctor about how to make breastfeeding easier for you and your child. Your doctor may recommend you to a lactation specialist or a pediatric nutritionist depending on the kind of issue you are facing.

Your baby may get more sick than other babies as they may get infections fast. Sometimes they may get so sick that they may need hospitalisation. Hence it is most important to take extra precautions and ensure your child is healthy.

Ensure everyone in the family gets a flu shot and all the other vaccinations as suggested by your doctor. Avoid taking your baby to crowded places where they may catch infections easily. Wash your hands frequently and ensure whoever touches your child also does the same.

Sources:

• https://www.mayoclinic.org/diseases-conditions/congenital-heart-defects-children/symptoms-causes
• https://medlineplus.gov/congenitalheartdefects
• https://www.nhlbi.nih.gov/health/congenital-heart-defects
• https://www.nhs.uk/conditions/congenital-heart-disease/prevention/
• https://www.mayoclinic.org/diseases-conditions/congenital-heart-defects-children/diagnosis-treatment
• https://familydoctor.org/how-to-care-for-your-baby-and-yourself/