Neonates with left-sided obstructive heart disease: clinical manifestation and management at primary care hospitals.

BACKGROUND

In neonates, left-sided obstructive heart defects are critical diseases requiring early recognition, initial stabilization, and transfer to Cardiac Center.

OBJECTIVES

To assess management of these neonates in primary care hospitals.

METHODS

Retrospective analysis of medical records of neonates admitted to Cardiac Intensive Care Unit in whom diagnosis of left-sided obstructive heart defect was established.

RESULTS

During 8-year period records of 117 patients were evaluated. Of those, 83 had hypoplastic left heart syndrome, 13 aortic stenosis, 12 coarctation of aorta, and 9 interruption of aortic arch. In 13 (11%) patients diagnosis of heart defect was established prenatally, other neonates presented postnatally with heart failure (28.2%), shock (65.4%) or severe cyanosis (4.8%). Continuous infusion of PGE1 and dopamine was administered in 84.6% and 30.8% patients, respectively. Thirty-two (30.8%) patients were mechanically ventilated and 36 (34.6%) received sodium bicarbonate. In referring hospitals the heart defect was most often diagnosed using echocardiography and diagnosis was established accurately in 55% patients.

CONCLUSION

The study showed that in primary care hospitals neonates with known or suspected left-sided obstructive heart disease need more aggressive resuscitative measures than those used in this patient series. Prenatal diagnosis rate of these heart defects is very low (Tab. 3, Fig. 1, Ref 8). Full Text (Free, PDF) www.bmj.sk.