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Congenital Heart Disease in Children

Introduction

Children make the potential future populace with possibilities of enhanced creativity in their regime considerably high given the underlying exposure to contemporary technologies in the world. Infants are in most cases helpless and depend mostly on adults for proper growth and development. Research has indicated that a considerable number, approximately 9 percent, of babies die during birth, immediately after birth, or some days before birth, which indicates an extensive loss of prospective populace that is capable of making significant changes to the future world.

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Currently, global healthcare faces numerous challenges in protecting infants especially given the continuously evolving health complications that tarnish this profession. One of the renowned birth defects found in human beings currently is congenital heart disease with approximately 40,000 US-born infants affected annually. Despite significant research on this menace, little remains known about the causes, effects, and remedies to congenital heart disease. This study provides a comprehensive literature review that explores congenital heart disease in detail.

Synopsis of congenital heart disease

Congenital heart diseases (CHD) refer to serviceable or structural heart disease, presently identified during birth or discovered sometime after birth. “Congenital heart disease may as well refer to the structural anomaly of the heart of the great vessels, which has a real or potential functional significance” (Guitti 2000, p.401). The human heart is a paramount organ in the body that performs numerous functions and in case of failure, the probability of death is high. One challenging aspect of this defect is that doctors may not be in a position to point out the disease during birth since it contains few physical symptoms at this moment due to defect slightness.

Severe congenital heart diseases eventually lead to permanent heart malfunction that further leads to fatalities in children. Globally, the disease ranks among the most complicated birth defects that hamper general growth and development as it requires complicated medical care conditions coupled with economic impacts to families and parents bearing such children. Among infants and young children, congenital heart attack accounts for 30-50 percent transience.

Seemingly, the number of adults with some traces of congenital heart attacks is growing despite substantial growth in medical interventions and their intensified effectiveness. However, congenital heart diseases occur mainly in neonates, children, and infants, with repercussions of poor diagnosis felt in adulthood. Congenital heart disease (CHD) is not a regional matter and international reports documented on this matter link the menace to the international paradigm (Mitchell et al. 1971).

Statistically, numerous reports have proved significant in delivering extensive pediatric statistics in the trends and occurrence of congenital heart diseases with over 17 percent of infants born with this defection on birth. Despite a significant decrease of approximately 24.1 percent in the number of cases of infancy attacks across the world, the number in the mortality rates resulting from congenital heart attacks have remained significantly towering with sources indicating that somehow the rates are becoming unpredictable depending on regions. For the past decade, congenital anomalies accounted for 21 percent of child mortalities.

A special case report to the study

Congenital heart diseases are among the majority of pediatric emergency presentations across the world. One recent case might have prompted my attention to undertaking a comprehensive literature review that explores the issue of congenital heart attacks. Three women appear in the pediatrics care in an ambulance with their child aged 3years on average reporting to have cardiovascular and respiratory distress or rather collapses, shortness of breath, feeding difficulties, and physical collapse. On further questioning and medical interviews with the parents, they reported having accounted for such problems in their early lives.

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They also reported to have used a large amount of vitamin A, exposure to organic solvents, and used several therapeutic drugs during the pre-gestation period. The doctors then confirmed their conditions through the echocardiography diagnosis where Doppler and color flow imaging indicated that CHD was present that result in referrals to heart surgeries for the three children. Unluckily, only two kids managed to undergo successful heart surgeries with the third dying.

Symptoms of congenital heart diseases

A child diagnosed with congenital heart illness may produce some symptoms depending on the form of diagnosis and the extent of infection in the body. On proper diagnosis, the majority of children suffering from congenital heart disease in such cases have normally portrayed difficulties in breathing resulting from congestive heart failure and in eating. Some children have demonstrated murmurs on routine screening, physical collapse on the severity of the attack, feeding has nonetheless been a problem to the victims of CHD attacks, while some cases have led to total heart failure. In extraordinary diagnosis, doctors normally classify the severity of CHD in different categories according to the symptoms established (Hoffman & Kaplan 2002).

In severe cases of CHD attacks, patients may reveal pulmonary atresia or absence of pulmonary valve, presence of pulmonary valve with an intact ventricular septum, anomalies of Ebstein, anomalous pulmonary venous connection among other potential symptoms. In moderate attack, the victims may demonstrate mild/moderate aortic incompetence, large ASD, and complex forms of VSD.

The situation in developed economies

As postulated earlier, the aspect of congenital heart disease is not at any circumstance a regional or sectional disease and has always presented unique challenges in the contemporary healthcare world across all economies of the world. Continentally, the prevalence of congenital heart disease seems to vary though reports have indicated that the Asian continent leads in the pervasiveness of congenital heart diseases with approximately 9.3 per out of 1,000 live births having CHD, with a 95 percent confidence interval. It remains closely followed by the European continent with an approximated percentage of 8.2 percent CHD birth prevalence with a 95 percent confidence interval as well.

However, some reports have indicated considerably low prevalence rates in Africa, approximated to 1.9 percent of children affected by congenital heart disease at birth. Saxena (2005) echoed these findings by asserting, “the reported incidence of congenital heart diseases is 8-10 of 1000 live births according to various series from different parts of the word” (p.595). In developed economies, countries like the United States have long fought the battle against CHD.

The status of congenital heart diseases is becoming a constant challenge even in developed economies with approximately 40,000 children affected by CHD during birth. Despite great achievements in the management and control of congenital heart diseases in America and other developed countries including interceptive measures that involve controlling the CHD through accurate CHD diagnostics for the past six decades, much remains anticipated as the numbers of cases are considerably high.

While not much exists on possible contributors to such conditions, Van der Linde et al. (2011) avows, “Women in developed countries are delaying childbearing to an older age, maternal age has increased in the last decades, consequently causing a higher birth prevalence of congenital abnormalities” (p. 2245). According to a study conducted by Guitti (2000), England, Germany, Canada, Australia, the United States, and Slovakia have long been battling against CHD with England having 4.7 percent, Germany 7.1 percent, Canada 5.5 percent Australia 7.6 percent, the United States 4.5 percent and Slovakia 7.8 percent prevalence rates respectively.

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The situation in developing economies

Notwithstanding being a global aspect and having an impact to certain lengths in the developing nations, conditions seem much better compared to developed nations with severe cases felt in India as most exceptional in this case. The prevalence rates of the African continent that contains much of the developing nations have proved considerably low approximating to 1.9 percent of affected children. Demographics sometimes might have played a significant role in the disparity between the rates in the European continent and the African continent as findings documented by Van der Linde (2011) and Gilboa et al. (2013) reveal that CHD is uncommon among blacks or African Americans residing in North America.

Despite being fortunate against the attacks, there exists a high likelihood of high mortality rates resulting from CHD in developing nations, as compared to developed nations since the extent of care and expertise in handling CHD may lack. This assertion holds for the privilege towards advancement in CHD diagnosis remains limited in developing nations therefore high mortality and morbidity.

Adverse impacts of congenital heart attacks have been eminent in India as among developing nations due to underdeveloped healthcare systems. The healthcare system in India seems to be in its infant stage, with numerous births witnessed in the current decades with potentially risky deliveries since most births take place at home. In India, the prevalence of congenital heart disease ranges from 2.25-5.2 in every 1000 live births, though few studies demonstrate the presence of CHD in school-going children (Saxena 2005). Sticking to the example of India, approximately 10 percent of the current mortality rates in India, anaesthesiologists suspect result from DHD.

Another considerable study undertaken by Khalil (1994) indicates that there are significantly high rates of CHD in India as this study revealed that approximately 43 of 10,964 infants examined in a period of 28 months, had CHD. Brazil as one of the developing nations has also been battling CHD having 5.4/1000 prevalence rates in live births with the situation worsened by poor healthcare technical support due to poverty.

Possible causes of congenital heart disease

It is quite difficult sometimes to explain the concept behind the occurrence of congenital heart diseases, though much of biological science can figure it out from a certain angle. Normally, a newborn’s heart cannot appear to indicate congenital heart disease unless through accurate diagnosis that is currently achievable through managed care and contracted medical services (Gilboa et al. 2013). Anaesthesiologists have identified certain physiological concepts regarding the appearance and functioning of the heart of a newborn.

The hearts of newborns also have a right ventricle that remains moderately hypertrophied, which implies that the compliance of the heart about body activities remains weak making the heart more responsive to preload. The cardiovascular appearance of the heart system of an infant that also demonstrates high sensitivity to depressant effects of anesthetic agents may be the probable cause of frequent congenital heart attacks in infants as compared to adults.

Most frequently, according to medical research undertaken about CHD, the disease has some underlying factors that contribute to the adversity of its prevalence. Poor health infrastructure that lacks advanced technologies that are prerequisites to early detection of CHD might influence the prevalence of its attack. The introduction of echocardiography was one step that enabled proper diagnosis of CHD in clinical practice and enhanced the detection of mild lesions such as ventricular septal defect VSD or atria septal defect ASD.

Poor detection of VSD, which is the most common type of CHD normally results in severe cases of congenital heart attacks. However, “maternal pre-gestational diabetes mellitus, phenylketonuria, febrile illness, infections, various therapeutic drug exposures, vitamin A use, marijuana use, and exposure to organic solvents have proven to associate with increased risk of CHD” (Van der Linde et al. 2011, p.2245). Nonetheless, these are just contributing factors that possibly result in the occurrence of CHD, with most being the underlying health condition of parents of the child.

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Apart from Ventricular Septal Defect (VSD) and Atrial Septal Defect (ASD) as major causes of congenital heart attacks in children, echocardiography and clinical diagnoses that replaced invasive diagnoses have indicated other significant causes of CHD. Abdominal Patent Ductus Arteriosus (PDA), Coarctation of the aorta (Coach), Pulmonic Stenosis (PS), Aortic Stenosis (AS) among numerous heart anomalies are the probable causes of congenital heart disease. Inasmuch, among all the causes of congenital heart disease, Ventricular Septal Defect (VSD) is the main lesion that plays the most significant role in the cause of CHD with reports indicating the highest prevalence of up to 3,570 per every million live births internationally.

Nonetheless, aspect of biasness in the unavailability of technical practitioners or lack of medical equivalence has been the definite cause of poor recordings and unsatisfactory results of CHD diagnoses across the world. Despite genetic factors being focal to the occurrence of CHD to certain lengths, mother to child surveillance shows that the probability of mothers affecting children is 2.5 percent and 18 percent while fathers are 1.5 percent and 3.0 percent.

Established effects of congenital heart disease

The severity of congenital heart disease and its impact on children’s health depends on the quality and timeliness of the management of CHD. Due to improved diagnosis of CHD, doctors and physicians are currently capable of handling CHD at early stages especially at birth, providing substantial care, management, and cure. However, on late realization and poor diagnosis of CHD, the possibilities of this condition resulting in serious anomalies remain relatively high. In most cases, children diagnosed with CHD have undergone heart surgeries some of which do not prove successful and therefore set the lives of several neonates, infants, and children at fatal risks.

A left-to-right shunt of the heart normally results in pulmonary hypertension following the high blood volume pumped from the right side of the heart. White (2009) affirms, “The excessive pulmonary blood flow (PBF) from the underlying left-to-right shunt also means that these infants are at risk of pulmonary hypertension” (p.505). Of several cases of hypertension left-to-right, shunt lesions play a significant role.

Adverse impacts of CHD have been infective endocarditis, subacute bacterial endocarditis, cyanosis as a CHD type results in polycythemia and paradoxical embolism that results in stroke and other physiological defects. From a study undertaken by Rijen et al. (2004), aiming to examine the impact of CHD surgeries on the growing number of survivors in Europe, severe effects of surgical survival appeared especially on the aspects of the behavioral and emotional problem in the survivor’s adulthood. This study noted that early hospitalizations of newborns had adverse effects on their emotionality and other behavioral aspects of survivors in their adulthood.

Iyer et al. (2004) assert, “Patients who underwent surgery for ventricular septal defect and transposition of the great arteries have a higher risk of developing particularly externalizing problems, e.g. intrusive and aggressive behavior” (p.580). Conditions and restrictions imposed on victims as control, management interventions have normally involved restrictions towards maximum exercise capacity, reproductive issues, and other forms of lifestyle are potential attribution to overall problems.

Possible Prevention, care, management, and treatment remedies

Typically, congenital heart diseases have proved challenging as physicians have not managed to establish any prevention approaches to assists in controlling CHD. Nonetheless, avoiding risk factors like lifestyle aspects including drug and alcohol intake on the pre-gestation period might remain significant preventive measures, though the aspect of genetics might hamper such efforts and result to CHD anomalies.

In developed nations as Canada and U.S vaccination against rubella that is a common syndrome, that influences the occurrence of congenital heart diseases to a certain extent. In several cases, newborns rarely understand what management of CHD means and thus it is usually the responsibility of parents or caretakers to ensure effective management of CHD (Carey 2002). Taking care of individuals suffering from CHD, especially children has always been a challenge to the caregivers and parents since CHD under numerous circumstances requires expert cardiologic care. Anaesthesiologists have always recommended specialised care to victims that normally challenge parents or caregivers with little or no tending experience.

Central to the aspect of caring in congenital heart attacks problems, management of the diseases is more practical where caregiver must remain equipped with materials necessary for guiding the management practice. According to physicians, severe complications resulting from CHD may require resuscitation council guideline to babies and frequent assessment and hospital checkups inclusive of prostaglandin infusion for the ductus-dependent lesions to identify the condition of the children.

When the condition of the newborns seems to be heavily risking the regular pumping of the blood and other heart activities including blood circulation and the oxygenation or even causing a strain in the heart and lungs, doctors may recommend special surgical correction where parts causing conflicts undergo improvement. Apart from surgical intervention, medical practitioners, through anaesthetic management may opt to correct such heart problems using non-surgical intervention including the introduction of balloon valvotomy to support the newborns heart functionality.

Conclusion

Congenital heart disease (CHD) has been a constant challenge in the global healthcare paradigm and the situation seems incompletely settled as variance in technological advancement among countries is hampering medical efforts to curb CHD. Despite great prevalence of CHD in developed nations with the continental comparison revealing that Asia and Europe are leading in the prevalence of CHD, the problem might remain a challenge ever to the developing world following the poorly infrastructural availability. CHD are unique in there appearance as they normally occur during the gestation period and their prevention may remain confronting to medical practitioners.

However, the advent of clinical and echocardiographic diagnoses has enhanced the diagnosis of CHD with accuracy that results in few misdiagnoses. By parents reducing their lifestyle behaviours including alcohol intake may greatly help in preventing the occurrence of CHD, though genetics may remain a challenge to the prevention of the CHD incidences. Surgery will remain the most effective approach to manage CHD.

Reference List

Carey, K, Nicholson, C & Fox, R 2002, ‘Maternal Factors Related to Parenting Young Children with Congenital Heart Disease’, Journal of Paediatric Nursing, vol. 17 no. 3, pp. 1-19.

Gilboa, S, Salemi, J, Nembhard, W, Fixler, D & Correa, A 2013, ‘Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006’, American Heart Association, vol. 122 no. 22, pp. 2254-63.

Guitti, J 2000, ‘Epidemiological Characteristics of Congenital Heart Diseases in Londrina, Paraná South Brazil’, Arq Bras Cardiol, vol. 74 no. 5, pp. 400-404.

Hoffman, J & Kaplan, S 2002, ‘The Incidence of Congenital Heart Disease’, Journal of the American College of Cardiology, vol. 39 no. 12, pp. 1890-1900.

Iyer, S, Anderson, J, Slicker, J, Beekman, R & Lannon, C 2011, ‘Using statistical process control to identify early growth failure among infants with hypoplastic left heart syndrome’, World Journal for Paediatric and Congenital Heart Surgery, vol. 2 no. 4, pp. 576-585.

Khalil, A, Aggarwal, R, Thirupuram, S & Arora, R 1994, ‘Incidence of congenital heart disease among hospital live births in India’, Indian Paediatrics, vol. 31 no.5, pp. 519-527.

Mitchell, S, Korones, B & Berendes, H 1971, ‘Congenital Heart Disease in 56,109 Births Incidence and Natural History’, Circulation, vol. 43, pp. 323-332.

Saxena, A 2005, ‘congenital heart disease in India: A status report’, Indian Journal of Paediatrics, vol.72, no. 7, pp. 595-598.

Van der Linde, D, Konings, E, Slager, M, Witsenberg, M, Helbing, W, Takkenberg, J, Roos-Hesselink, W 2011, ‘Birth Prevalence of Congenital Heart Disease Worldwide: A systematic review and meta-analysis’, Journal of the American College of Cardiology, vol. 58 no. 21, pp. 2241-2247.

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