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How does congenital heart disese affect the growth and development of a child ?

Posted Dec 16 2010 12:55pm

Heart is the first organ to differentiate in the fetus.The first heart beat begins on the 22nd day of fetal life ! . From that day , it’s function is linearly determine the   fetal growth  .It continues in the new-born,  infancy and  up to late child hood.

It is no surprise  then, to detect growth retardation in congenital heart disease. A proper evaluation begins right from fetal mass / birth weight estimation  .Motor and cognitive milestones should be assessed meticulously .

The pattern of growth affliction is  complex  and poorly understood.Few  working rules are  often taught in cardiology classrooms.

Caution : This is a too simplified version. Discerned readers should consult all sources cited here.

Acyanotic heart disease

ASD, VSD, PDA  tend to affect weight gain  more but generally do not affect height  much  . But, the onset of pulmonary  hypertension early in the course will severely  affect height as well.

Co arctation of  Aorta and other Aortic interruptive   diseases  can have a differential  affection of growth . (Upper part of body > Lower part)

Cyanotic heart disease

CHD  affects both height and weight proportionately. Cyanotic  heart disease with increased pulmonary blood flow  the overall survival is less ,  recurrent failure is common  and hence growth and development is more affected.

The mechanism of stunted  growth.

The often used terminology  ‘failure to thrive” , may not be attributed to heart disease per-se. It has to be multi factorial and  is related to  social well-being  ,  feeding habits , and mother’s effort  , interruptions due to co existing illness , effects of surgery  etc. Obviously these factors operate  more  in infants with increased pulmonary blood flow.

Effect  on cognitive function

Contrary  to the expectations  even chronic hypoxia and cyanosis has no compelling effects  on the child’s intelligence . Unless there is co existing  neurological defects severe compromise of cognition  is  uncommon.

However now we realise , brain development do  suffer   in hypoxic environment.In fact, the damage  to cognition could start right from the fetus .

New evidence is coming  up.

*Recurrent hypoxia spells and convulsions in TOF  can lead to reduced cognition

Is the normal  growth  and development   restored after complete correction of the disease by  cardiac surgery ?

The expected benefit is usually achieved  . The catch up occurs . But it is not guaranteed,   especially in  cyanotic heart disease. As , many times the  destined growth of a child   is  reprogrammed and  predetermined  in the fetus itself.


References  on Growth impairment in congenital heart disease

 

R. L. Naeye, “Anatomic features of growth failure in congenital heart disease,” Pediatrics, vol. 39, no. 3, pp. 433–440, 1967.

A. Mehrizi and A. Drash, “Birth weight of infants with cyanotic and acyanotic congenital malformations of the heart,” Journal of Pediatrics, vol. 59, no. 5, pp. 715–718, 1961.

R. J. Levy, A. Rosenthal, D. C. Fyler, and A. S. Nadas, “Birthweight of infants with congenital heart disease,” American Journal of Diseases of Children, vol. 132, no. 3, pp. 249–254, 1978.

H. H. Kramer, H. J. Trampisch, S. Rammos, and A. Giese, “Birth weight of children with congenital heart disease,” European Journal of Pediatrics, vol. 149, no. 11, pp. 752–757, 1990.


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