Category Archives: Cardiac

Tip 41: congenital heart disease

The prevalence of structural congenital heart disease is approximately 5 per 1,000 total births (~0.5%). The antenatal diagnosis of serious congenital heart disease is only 50%. The incidence of heart murmurs on day 1 examination, however, may be as high as … Continue reading

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Tip 39: persistent pulmonary hypertension of the newborn (PPHN)

The main principles for managing persistent pulmonary hypertension of the newborn (PPHN) are: Treat & prevent hypoxia – aim pO2 ≥10 kPa and/or sats ≥95% (preductal) Treat acidosis – aim pH ≥7.35 Treat & prevent hypotension – aim BP > … Continue reading

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Tip 196: cyanotic congenital heart disease 2

The cyanotic causes of congenital cardiac disease in the neonatal period can be split into: Those with right to left shunt: Pulmonary atresia Tricuspid atresia Ebstein’s anomaly Those with common mixing: Truncus arteriosus, double inlet / outlet ventricles Transpositon of the Great Arteries (TGA) Total … Continue reading

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Tip 194: cyanotic congenital heart disease

Clinical features suggesting a cardiac cause of cyanosis include: Family history of congenital heart disease Antenatal diagnosis / concerns of cardiac anomaly Clear cardiac signs Little / absence of respiratory distress Presence of shock / metabolic acidosis Cyanosis not improving … Continue reading

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Tip 193: PDA 3

The clinical features of a patent ductus arteriosus include: Bounding pulses Active precordium (presence of ventricular heave) Continuous / systolic murmur in pulmonary area (left infraclavicular) Respiratory distress failing to improve or deteriorating at 5 – 10 days of life, including apnoea … Continue reading

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Tip 159: pulse oximetry screening

PulseOx is a large multicentre UK study of pulse oximetry screening (~20,000 neonates >35/40). 53 had major congenital heart disease (24 critical), a prevalence of 2·6/1000 live births. 35 were suspected from antenatal ultrasound scan. After excluding these, the sensitivity of pulse … Continue reading

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Tip 147: hydrocortisone for hypotension

Hydrocortisone is effective in increasing blood pressure, with few other acute side-effects in the sick preterm infant. However, benefit data and long-term safety data are unknown. It is likely that it works by improving the immature neonatal stress response (due to … Continue reading

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