Cardiac abnormalities in birth asphyxia.

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dc.contributor.authorRanjit, M Sen_US
dc.date.accessioned2000-03-29en_US
dc.date.accessioned2009-05-30T16:21:00Z
dc.date.available2000-03-29en_US
dc.date.available2009-05-30T16:21:00Z
dc.date.issued2000-03-29en_US
dc.description11 references.en_US
dc.description.abstractCardiac abnormalities in birth asphyxia were first recognised in 1970s. These include (i) transient tricuspid regurgitation which is the commonest cause of a systolic murmur in a newborn and tends to disappear without any treatment unless it is associated with transient myocardial ischemia or primary pulmonary hypertension of the new born (ii) transient mitral regurgitation which is much less common and is often a part of transient myocardial ischemia, at times with reduced left ventricular function and therefore, requires treatment in the form of inotropic and ventilatory support, (iii) transient myocardial ischemia (TMI) of the newborn. This should be suspected in any baby with asphyxia, respiratory distress and poor pulses especially if a murmur is audible. It is of five types (A to E) according to Rowe's classification. Type B is the most severe with respiratory distress, congestive heart failure and shock. Echocardiography helps to rule out critical left ventricular obstructive lesions like hypoplastic left heart syndrome or critical aortic stenosis. ECG is very important for diagnosis of TMI, and may show changes ranging from T wave inversion in one lead to a classical segmental infarction pattern with abnormal q waves. CPK-MB may rise and echocardiogram shows impaired left ventricular function, mitral and/or tricuspid regurgitation, and at times, wall motion abnormalities of left ventricle. Ejection fraction is often depressed and is a useful marker of severity and prognosis. Treatment includes fluid restriction, inotropic support, diuretics and ventilatory resistance if required, (v) persistent pulmonary hypertension of the new born (PPHN). Persistent hypoxia sometimes results in persistence of constricted fetal pulmonary vascular bed causing pulmonary arterial hypertension with consequent right to left shunt across patent ductus arteriosus and foramen ovale. This causes respiratory distress and cyanosis (sometimes differential). Clinical examination also reveals evidence of pulmonary arterial hypertension and right ventricular failure with systolic murmur of tricuspid and, at times, mitral regurgitation. Treatment consists of oxygen and general care for mild cases, ventilatory support, ECMO and nitric oxide for severe cases. Cardiac abnormalities in asphyxiated neonates are often underdiagnosed and require a high index of suspicion. ECG and Echo help in early recognition and hence better management of these cases.en_US
dc.description.affiliationSri Ramachandra Medical College and Research Institute, Porur, Chennai, T.N. 600116.en_US
dc.identifier.citationRanjit MS. Cardiac abnormalities in birth asphyxia. Indian Journal of Pediatrics. 2000 Mar; 67(3 Suppl): S26-9en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/84483
dc.language.isoengen_US
dc.source.urihttps://medind.nic.in/icb/icbai.shtmlen_US
dc.subject.meshApgar Scoreen_US
dc.subject.meshAsphyxia Neonatorum --etiologyen_US
dc.subject.meshDiagnosis, Differentialen_US
dc.subject.meshElectrocardiographyen_US
dc.subject.meshHeart Defects, Congenital --complicationsen_US
dc.subject.meshHumansen_US
dc.subject.meshInfant, Newbornen_US
dc.subject.meshMitral Valve Insufficiency --complicationsen_US
dc.subject.meshMyocardial Ischemia --complicationsen_US
dc.subject.meshPersistent Fetal Circulation Syndrome --complicationsen_US
dc.subject.meshPrognosisen_US
dc.subject.meshTricuspid Valve Insufficiency --complicationsen_US
dc.titleCardiac abnormalities in birth asphyxia.en_US
dc.typeJournal Articleen_US
dc.typeReviewen_US
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