Congenital Heart Disease

Congenital heart disease refers to structural abnormalities of the heart present from birth, resulting from abnormal heart development during pregnancy. Severity ranges from mild defects that may never need treatment to complex conditions requiring surgery in infancy.

• Some defects cause no symptoms and are found incidentally, such as on routine examination
• Rapid or difficult breathing, particularly during feeding
• Poor feeding and poor weight gain
• Bluish discolouration of the lips, skin, or nail beds (cyanosis) in more significant defects
• A heart murmur detected on examination
• Fatigue or breathlessness with exertion, which may become apparent as the child grows

• Results from abnormal development of the heart during early pregnancy, though the exact cause is often not identified in an individual case.
• Risk factors include certain maternal infections during pregnancy (such as rubella), poorly controlled maternal diabetes, some maternal medicines or substance use during pregnancy, and certain genetic conditions.
• Family history of congenital heart disease can also increase risk.

• Suspected based on findings on newborn or infant examination, such as a heart murmur, abnormal breathing pattern, poor feeding, or cyanosis.
• Echocardiography, where available, is the key test used to confirm the specific structural abnormality and guide management.
• Pulse oximetry screening in newborns, where available, can help detect some critical heart defects before symptoms become obvious.

Management depends entirely on the specific type and severity of the defect, ranging from simple monitoring for mild defects that may close or remain insignificant over time, to surgery for more significant structural problems.

Some defects require medicine to manage symptoms such as fluid overload or to support heart function while awaiting definitive treatment.

More significant defects require referral to a specialist paediatric cardiology and cardiac surgery centre, sometimes urgently in the newborn period for critical defects.

Children with congenital heart disease benefit from coordinated, ongoing follow-up to monitor growth, development, and heart function over time.

• Attend all recommended antenatal care visits, which can sometimes detect heart defects before birth through ultrasound.
• Ensure rubella immunity before pregnancy through vaccination, since rubella infection in pregnancy is a preventable risk factor.
• Manage pre-existing diabetes well before and during pregnancy.
• Avoid alcohol and unnecessary medicines during pregnancy unless advised by a health worker.
• Seek prompt assessment for any newborn or infant with poor feeding, rapid breathing, or bluish discolouration.