Source: The Hitavada      Date: 02 Jul 2018 12:25:01




By Dr Vivek Ravi

Charde ow-a-days percentage of heart disease is on rise. Stress, irregular lifestyle, consumption of junk food, lack of exercise, smoking and alcohol consumption are some of the responsible factors. Heart disease is also seen in children even in newborn babies though types of cardiac problems are different. We are going to discuss important aspects of childhood heart diseases in this article. Let’s first see the magnitude of the problem. Out of 1000 children born, approximately 6 to 8 children have heart disease. In some region, this incidence goes up to 15 per 1000. Approximately half of these need immediate treatment. Now let’s discuss what symptoms of childhood heart diseases are. It depends on the age of patient. Newborns may have difficulty in respiration immediately after birth which may need oxygen and ventilator support. They may have bluish discolouration of lips, hands and legs. Newborn may have difficulty in breast feeding. They may take small amount of milk or take milk very slowly as they get tired quite easily. This cycle is called ‘suck-rest-suck’ cycle. Also they may have breathlessness and sweating over forehead while feeding. As children grow older, they have repeated cough and cold, sometimes pneumonia as well. Palpitation, swelling on hands and feet, excessive weakness and tiredness are also important symptoms. Their height and weight do not grow and these children remain stunted and malnourished.

If left untreated, they develop serious complications which includes pulmonary hypertension (increased pressure in lung’s arteries), endocarditis (infection of heart) and stroke (paralysis). Now let’s see which children are at high risk for acquiring heart diseases. If parent’s marriage is in relation (consanguineous marriage), if sibling has heart disease, if mother contacts infection like rubella during pregnancy, if mother has diabetes, thyroid or SLE during pregnancy, if there is radiation exposure or consumption of certain medication like phenytoin, lithium etc during pregnancy then chances of heart disease in newborn increases. Also elderly mother (more than 35 year old at the time of pregnancy) has more risk of delivering a baby with heart disease. Now let’s discuss in brief what treatment modalities are. Medicine and surgery are two treatment options available. Medicines are generally given to stabilise heart. Some diseases like (ASD and VSD) may spontaneously correct as the child becomes older.

In such babies, careful observation and follow up are necessary. Some of these may not respond to medical treatment and need surgical intervention. Some children are born with very complex heart problems and need immediate surgical correction. There are some preventive measures. Prospective mothers should avoid unnecessary medications, X-ray exposure and addiction during pregnancy. The High risk group mothers should be in regular followup with their gynaecologists and have regular sonography and blood tests done during pregnancy. If heart disease is detected in infant then delivery should be done in a centre where paediatric heart specialist is available so that immediate treatment after birth can be started if needed.Teenage girls should be vaccinated with Rubella vaccine. Heart surgery is a costly affair so for under-privileged and low socio-economic group, Government has started schemes like Mahatma Jyotiba Fule Jan ArogyaYojna, Chief Minister Relief fund etc. Also many NGOs are also participating in aid for these children.With advancement in medical knowledge and technology, heart surgery in children has become much safer than they used to be in the past. The complex heart problem which were considered inoperable a few years ago can now be treated successfully and children can enjoy normal life. (The author is paediatric cardiac intensivist) ●