the common neonatal defects

1. college of health science Department of
midwifery
Post graduate program
Presentation on Neonatology
by: Redae Maldey

2. Outlines of the presentation
• Introduction
• Ventricular septal defect
• Patent ductus arteriosus
• Tetralogy of fallot

3. Introduction
• CHD refers to one or more problems with the heart
structure that are present at birth.
• Some are simple ,no need of treatment
• Others are more complex and may require several
surgeries

4. Epidemiology of CHD
Incidence - 8/1000 live births
- 3-4/100 still born
- 2/100 premature infants excluding PDA
- 10-25/100 abortuses
• Most congenital defects are well tolerated during fetal
life.
Etiology - Unknown in most cases
- Genetic factors - single gene defect
- Chromosomal abnormality.
- Environmental factors

5. VSD
• A ventricular septal defect (VSD) is a defect in
the ventricular septum, the wall dividing the left and
right ventricles of the heart. The extent of the opening
may vary from pin size to complete absence of the
ventricular septum, creating one common ventricle
• hole b/n lower heart chambers(ventricles)
• The most common cardiac malformation

8. Causes
• Down syndrome
• due to mechanical tearing of the septal wall
• Diagnosis
• Echocardiographic
• cardiac auscultation pathognomonic holo-
or pansystolic murmur

9. Signs and symptoms
• Ventricular septal defect is usually symptomless at
birth. It usually manifests a few weeks after birth.
• VSD is an acyanotic congenital heart defect, a left-
to-right shunt so there are no signs of cyanosis
• Pansystolic (Holosystolic) murmur along lower left
sternal border

10. Treatment
 Treatment is either conservative or surgical. Smaller
congenital VSDs often close on their own, as the
heart grows, and in such cases may be treated
conservatively.
 Some cases may necessitate surgical intervention

11. PDA
• Patent ductus arteriosus (PDA) is a condition
where in the ductus arteriosus fails to close
after birth
• An uncorrected PDA may lead to congestive heart
failure with increasing age
• Common symptoms include
• tachycardia (a heart rate exceeding the normal resting
rate)
• respiratory problems
• dyspnea (shortness of breath)

14. Signs of PDA include:
• continuous "machine-like" heart murmur
during systole and lower flow during diastole)
• cardiomegaly (enlarged heart)
• left subclavicular thrill
• bounding pulse
• widened pulse pressure
• increased cardiac output
• increased systolic pressure
• poor growth

15. Treatment
• Neonates without adverse symptoms may simply be
monitored as outpatients, while symptomatic PDA
can be treated with both surgical and non-surgical
methods

16. Tetralogy of fallot
 Congenital heart defect with four structural defects.
 Oxygen poor blood to flow out of heart and
into the rest of the body.
 risk factors include:-
a viral illness such as rubella during px
maternal alcoholism or family Hx of the
condition

17. TOF Consists: RAPS
1.Right ventricular hypertrophy
2.Aorta displacement
3.Pulmonary stenosis
4. Septal defect (Ventricular)

19. Clinical Manifestation
- Rarely pink TOF - in the absence of obstruction
- Cyanosis
- Clubbing
- Squatting position in walking children
- Paroxysmal hypercyanotic attacks
 occur during 1st 2 years
- Systolic ejection M
- Delayed growth & development
- Single 2nd heart sound

20. Diagnosis
CXR - Narrow base & uplifted apex
- A boot or wooden shoe
- decreased pulm. vascularity
- Right side aortic arch in 20%
ECG
Echocardiography
Complication
- Cerebral thrombosis - in < 2 years
- Brain abscess
- Infective endocarditis
- Polycythemia
- CHF in pink TOF

21. Treatment of TOF
• Requires surgery
temporary( open stenosis)
complete repair patch VSD (around 6-12months)
alprostadil ( prostaglandin E,keep ductus
Arteriosus open