Imtiaz Ahmad, Tehmina Kazmi, Najam Haider, Masood Sadiq.
Clinical presentation, diagnosis and outcome of neonates with suspicion of congenital heart disease in a Tertiary Care Hospital.
Pak J Med Res Jan ;57(4):144-8.

Objective: To determine correlation of various signs and symptoms with echocardiography findings in neonates. Short term outcome of patients with confirmed congenital heart disease (CHD). Study design, settings and duration: A comparative cross sectional study was carried out at Department of Cardiology and Neonatology, the Children Hospital & the Institute of Child Health, Lahore from January to December 2016. Subjects and Methods: A total of 514 neonates with clinical suspicion of CHD were included and underwent echocardiography. The neonates who had persistent pulmonary hypertension, patent ductus arteriosus less than 3 days of age and patent foramen ovale were excluded. The neonates with confirmed CHD were followed up for hospital outcome. Data was collected on a pre-designed proforma. Statistical analysis was performed using SPSS 20. Results: The mean age was 6.1 (0-28) days. CHD was present in 70 (13.61%) patients; 44 (63%) males and 26 (37%) females. Of these, 38 (54.28%) had cyanotic CHD while 32 (45.71%) had acyanotic CHD. Among the neonates having CHD, there were 41 (58.57%) preterm. Tachypnea (68.75%) and heart murmur (65.62%) were statistically significant with clinical signs in acyanotic heart disease while cyanosis (97.36%), tachypnea (RR >60) (92.10%) and heart murmur (34.21%) had significant association with cyanotic heart disease. Ventricular septal defect (VSD) was the commonest acyanotic CHD 8/32 (25%) whilst transportation of the great arteries (TGA) with VSD was the commonest cyanotic CHD 8/38 (21%).Fourteen neonates had critical congenital heart disease undergoing surgery or intervention 14/70 (20%). Three neonates with co-aractation of the aorta underwent surgery with one death. Six neonates for critical aortic and pulmonary stenosis underwent successfully balloon valvuloplasty. Four patients with TGA intact septum had successful balloon atrial septostomy. One neonate with infra-cardiac total anomalous pulmonary venous connection (TAPVC) underwent surgery but expired. The overall hospital mortality was 2.85%. Conclusion: Congenital heart disease was present in only 13.61% of the referred newborns with suspected CHD. The yield was high in preterm babies and for cyanotic CHD. Cyanosis and tachypnea, were major clinical signs pointing towards CHD. The neonates with critical congenital heart disease had a high mortality.

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