TACHYPNIC NEOANTE: IS IS A CHD: APPROACH TO A CHILD WITH CONGENITAL HEART DISEASE

ZOOM E LECTURE

1. Tachypneic neonate: Is it a heart disease? A common dilemma Dr. Murtaza Kamal MD, DNB (Peds), DNB SS (Peds Cardiology) Co Founder MAM Academy Dt: April 13, 2020

2. Keep at the back of your mind… 20 mins talk f/b discussion for another 10 mins : So, no mental fatigue… Type your queries in the chat box as the lecture goes on If time doesn’t allow mail me: [email protected]

3. A dialemma… 2 days term, good wt neonate presented in ER Tachypnic, no clinical cyanosis, sats: 90% Tachycardia, not sure of any murmur, liver 2cm below costal margin Dialemma… CHD or not??? Is it so rare?? No: 8-10/1,000 live births: MC birth defect

4. 5 Basic Questions to be answered… 1. Is it a CHD?? 2. If yes: Cyanotic or acyanotic?? 3. Pulmonary Blood flow: Increased?? 4. PAH: +/-?? 5. Duct dependent lesion??

5. Fetal circ

6. Q1: CHD or not?? Hyperoxia test?? Nada’s Criteria?? Echocardiography

7. Hyperoxia test… ABG (PO2 and not SPO2) 100% O2 X 10 mins Rpt ABG (PO2) PO2> 200—> Points towards respiratory pathology < 150—> Points towards CCHD

8. NADA’S CRITERIA… (1M/ 2mi) Major: Cyanosis CHF Systolic murmur grade 3 or more Diastolic murmur Minor: Abnormal BP Abnormal 2nd heart sound Systolic murmur Grade 1 or 2 Abnormal CXR Abnormal ECG

9. Q2: Cyanotic/ Acyanotic?? Wonder nos: 94 and 85 Acyanotic: Shunt/ Obstructive/ Regurgitant lesions Cyanotic Decreased PBF/ Increased PBF/ Normal PBF

10. Q3: PBF increased?? CHF (Tachypnea, tachycardia, hepatomegaly) Suck rest suck cycle Excessive sweating FTT Repeated chest infections

11. Q4: PAH?? Pressure= Flow x resistance Hyperkinetic/ obstructive??

12. Q5: Duct dependent lesion??

13. So whom to refer??? All cyanotic babies Duct dependent lesions Absent pulses CHF Feeding difficulty, excessive sweating, FTT, failure to gain appropriate weight

14. Role of prostin (E1) 1 vial of 1ml has 500micrograms; Dose of prostin: 5-100 ng/kg/min Eg: A baby of 1kg is to be started on pristin at 10ng/kg/min= 10x 1x 60= 600 ng/hr Mix 1 ml of Prostin in 49 ml of D5, then 50 ml has 500 microg = 500x 1000 ng, So 500x 1000ng is in 50ml of solution 1ng will be in 50ml/ 500 x1000= 1/ 10,000 ml; So, 600 ng will be in= 1/10,000 x 600= 0.06 ml So, to this child of 1 kg to start Prostin @ 10ng/kg/min—> You need to give 0.06ml/hr of this solution So, a child of 3 kg to start Prostin @ 10ng/kg/min—> You will give 0.06 x 3= 0.18 ml/hr (approx 0.2 ml/hr) FORMULA: 0.06 X wt (kg)/ hr OF THIS DILUTION—> WILL GIVE THE CHILD@ 10ng/kg/min Precaution***

15. Lets discuss… So, CHD is not so rare: MC birth defect Always keep an high index of suspicion Look for signs of CHF, cyanosis, murmur, pulses… Spo2 assessment of pre and post ductal parts of neonates advisable Discuss the case with your pediatric cardiology friend… ( [email protected] )