Possible Newborn Health Problems
Gastro-intestinal Tract Disorders
Unusual Blood Results
How are heart defects
Sometimes a heart defects is suspected because a baby
is breathless or sweaty or a murmur is heard.
baby with Down syndrome may seem perfectly well but still have
a major heart defect, which can lead to serious problems if
This means it
is very important that all our babies have their hearts carefully
checked soon after birth by a paediatricians examination
and by an echocardiogram.
An echo is very
similar to an ultra-sound scan like those performed in pregnancy
and gives a moving picture of your babys heart.
The echo will
show if your baby has a heart defect and your paediatrician
will decide if further tests are needed or if your baby needs
to be referred to the heart unit in Auckland.
How do heart defects occur?
A defect occurs when a babys heart starts to develop
in the usual way but does not develop fully. It may help to
reread the section on usual development.
If the problem happens at birth then
the baby may have a patent ductus arteriosus.
If the problem happens in early pregnancy
then part of the central heart structure will be missing and
the baby will have a septal defect or hole in the heart.
This can be an atrial septal defect, a ventricular septal defect
or an atrioventricular septal defect.
What do our babies echos show?
55% have a healthy heart with no defect
20% have an atrioventricular septal
10% have a ventricular septal defect
15% have another defect, often a patent
ductus arteriosus (PDA) or an atrial septal defect (ASD)
What is a Patent ductus arteriosus (PDA)?
A patent ductus arterious occurs when the blood vessel
between the aorta and main pulmonary artery (that all babies
require before birth) fails to close at birth.
It is a very common problem in premature
Why do septal defects occur?
Septal defects occur when a babys heart development
is interrupted early in pregnancy.
There are problems with the development
of the central structures of the heart from the endocardial
Defects (holes) can occur in any of
these structures (the atrial septum, the ventricular septum
and the valves between the atria and ventricles).
What is an atrial-septal defect (ASD)?
An ASD is a defect (hole in the heart) in the atrial
septum between the receiving chambers of the heart, the left
and right atria.
What is a ventricular septal defect (VSD)?
A VSD is a defect (hole in the heart) in the ventricular septum
between the pumping chambers of the heart, the left and right
In our babies the VSD is usually in the part
of the septum nearest the mitral and tricuspid valves so may
be called a VSD of the AV canal type.
What is an Atrioventricular septal defect
An AVSD can also be called
an atrioventricular canal defect (AV canal) or
an endocardial cushion defect
There are three types of AVSDs.
partial or incomplete AVSD
- Complete AVSD
a complete AVSD has three abnormalities
a defect (hole in the heart) in the atrial septum between the
receiving chambers of the heart, the left and right atria
a defect (hole in the heart) in the
ventricular septum between the pumping chambers of the heart,
the left and right ventricles
just one common AV valve
instead of separate mitral and tricuspid valves.
- Partial or incomplete AVSD
a partial AVSD has three abnormalities less severe than those
of a complete AVSD
an ostium primum atrial septal defect (a small hole in
the heart between the receiving chambers of the heart, the left
and right atria).
a small defect (hole in the heart)
in the ventricular septum between the pumping chambers of the
heart, the left and right ventricles.
usually a cleft in the mitral valve
that may cause the valve to leak.
- Transitional AVSD
a transitional AVSD looks similar to a complete AVSD but behaves
like a partial AVSD.
The leaflets of the common AV valve are
stuck to the ventricular septum making it seem like there are
two valves and no VSD.
Why do heart disorders
Septal defects and PDAs can cause problems because they
allow blood to cross from the left hand side to the right hand
side of the circulation.
This is called
a left-to-right shunt.
from left to right because the pressure in the left ventricle
is much higher than the pressure in the lungs.
of problems increases with
- the amount of blood shunted and
- increasing pressure in the vessels of the lungs.
What problems can
In order of severity problems are
with no other problems
Which babies get
If only a little blood is shunted, the body copes easily
and no problems are seen. This may occur in babies with
- partial ventricular septal defects
- atrial septal defects
- a small patent ductus arteriosus
Which babies just
get poor growth?
Poor growth with no other problems can occur in babies
- atrial septal defects,
- partial atrioventricular septal defects,
shunt occurs between the atria rather than the ventricles, so
pressure from the left ventricle is not passed on to the lungs.
The lung pressure
is not high so the baby is unlikely to develop the more serious
problems of congestive heart failure or pulmonary hypertension
But, the heart
is still working harder than usual to push extra blood through
Some of the
babys energy supply (food) must be used for the heart
to do this extra work so less is available for weight gain,
and growth may occur more slowly than in other babies.
Which babies get
congestive heart failure?
Congestive heart failure can occur in babies with
- complete atrioventricular septal defects
- large ventricular septal defects
- a large patent ductus arteriosus
- partial atrioventricular septal defects with very leaky mitral
What causes congestive
Congestive heart failure (CHF) is a combination of increased
heart and lung work because
the left side
of the heart works very hard
With each push most blood shunts to the right side of the
heart with only a little going to the body.
To get enough blood
into the body, the heart has to push out two to three times
more blood than normal.
High pressure is
passed on from the left ventricle to the lungs
too much blood
goes to the lungs
The vessels of the lungs are so full of blood that fluid leaks
from them into the air spaces of the lungs, making them
This is called pulmonary
oedema and makes it
hard for the lungs to work.
What problems does
congestive heart failure cause?
Babies with congestive heart failure may
than usual and use more of the muscles of their chest and abdomen
to help them breathe
have fast heart
rates, even when asleep.
that pump so hard you can easily feel and see the heart beat
on their chests
be sleepy and
problems and poor weight gain
often get chest
Each baby is different and will have a different
mixture of problems.
When does congestive heart failure develop?
Congestive heart failure does not usually occur as
soon as the baby is born.
This is because the pressure in the
lungs is high when babies are first born so less blood shunts
from left to right.
Symptoms gradually appear after two
to three weeks as the pressure in the lungs begins to fall and
more blood flows through the heart defect.
Which children get pulmonary hypertension?
Pulmonary hypertension occurs rarely in children with
complete atrioventricular septal defects
large ventricular septal defects
What causes pulmonary hypertension?
Pulmonary hypertension only occurs in conditions
where there is a large heart defect so that high pressure can
be transmitted from the left ventricle to the lungs.
In some babies with these severe heart
defects, the muscles around the small pulmonary arteries to
the lungs get bigger and constrict. This is to try to protect
the lungs from the extra blood flow and pressure passed on from
the left ventricle.
This is called pulmonary hypertension
and seems to happen more easily in babies with Down syndrome
than in other babies.
What problems does pulmonary hypertension
When the vessels constrict, there is less left-to-right
shunting, and so less signs of congestive heart failure.
Although this may mean that at first
a baby appears healthier, it is not a good sign.
Over time the muscles thicken permanently,
which cannot be cured.
The pressure in the lungs rises. After
a few years, the pressure in the lungs may become so high that
it is greater than that in the left ventricle
This means blood no longer shunts left
to right, but instead right to left. This is called Eisenmengers
Deoxygenated blood from the right side
of the heart can now go to the body and this gives the skin
a bluish tinge called cyanosis.
Not enough oxygen reaches the body
so the child gradually becomes more and more unwell and usually
dies as a teenager or young adult.
If it is possible to wait a few months or
the babys heart grows bigger
if surgery is needed, it is easier with a bigger heart
the defect may close or get smaller
Atrial septal defects
About half of ASDs will close themselves within the first 18
months of life so need no treatment
Ventricular septal defects
VSDs sometimes get smaller or close completely in the first
year of life, if this happens a baby may not need surgery.
Patent ductus arteriosus
A PDA will often close by itself in the first month of life
and need no treatment.
AVSDs never close by themselves and will always need open-heart
Waiting for surgery
You may be given a particular age or weight your baby needs
to reach before having surgery, this is often about ;
3-6 months for
babies with a complete atrioventricular septal defect
for babies with a ventricular septal defect or partial atrioventricular
2-4 years for
children with an atrial septal defect
If during this time
your baby develops congestive heart failure, treatment with
medicines may be tried.
If the medicines arent
helping or if the pressure in the lungs is becoming high surgery
will be needed more urgently.
Help with feeding
To help babies gain weight, special high calorie
powders may be added to their milk
The milk may
be given directly to a babys stomach through a nasogastric
tube so the baby does not have to use up energy by sucking.
are antibiotics given to a child who is well to prevent endocarditis.
with heart defects have an operation or dental treatment, bacteria
may enter their blood.
A clump of bacteria
may stick to the heart defect and cause endocarditis; a serious
infection of the lining of the heart that can be fatal.
will not occur if antibiotics are given before the operation
or dental treatment.
Medicines for congestive
Frusemide (lasix), or another diuretic is often
the first medicine given diuretics remove extra fluid from the
lungs, by making a baby pass more urine
or another medicine for lowering blood pressure may be used.
The heart has less work to do when it pumps against a lower
may be used to help the heart pump blood more efficiently.
Medicine for patent ductus arteriosus
In a newborn with a patent ductus arteriosus, a drug
called Indomethacin can be given.
This drug helps to constrict the muscle
in the wall of the patent ductus arteriosus to close it.
Patent ductus arteriosus
If a patent ductus arteriosus is still present beyond the newborn
period, it will generally never close on its own; The ductus
is tied off, a more minor procedure than open-heart surgery.
Atrial septal defects
Some atrial septal defects may be closed without open-heart
surgery. A device is inserted through a large vein into the
heart and attaches to the tissue around the atrial septal defect
to fill the hole.
Atrial septal defects may have the hole directly
closed with sutures or may need to be closed with a patch.
Ventricular septal defects need
to be closed with a patch.
Atrioventricular septal defects
have the septal defects closed with patches, and the common
atrioventricular valve reconstructed. The hardest part of the
surgery is dividing this single valve into two.
Open-heart surgery is performed at
the heart unit of Starship hospital, Auckland
After open-heart surgery a baby spends
around two days in intensive care and up to ten days in hospital.
Will my baby survive the operation?
Survival figures have improved dramatically over the past years
and it is now extremely rare (under 1%) for a baby to die during
surgery or immediately afterwards.
What will life be like afterwards?
Most heart defects are repaired completely and have no further
influence on a childs life. Children may need
Follow-up visits with the cardiologist
to assess heart function
Continued antibiotic prophylaxis for
What about complete AVSDs?
Repair of a complete atrioventricular septal defect
is often more complex especially if the lung pressure is high
Babies with these defects may have
They may need a longer time on a ventilator
and more medicines after surgery
They may still have heart problems following
- The opening in the mitral valve may now be too narrow or still
be very leaky.
- There may be narrowing of the path for
blood to pass from the left ventricle to the aorta
- The specialized tissue that conducts
the impulse for the heart to beat runs very near the area where
the stitches for the ventricular patch need to be placed. If
this is disrupted, placement of a pacemaker may be necessary
About 10% of these children will need
further surgery later.