BOOK
Cardiovascular Disease, An Issue of Clinics in Perinatology, E-Book
Nikhil K. Chanani | Shannon E.G. Hamrick
(2016)
Additional Information
Book Details
Abstract
The impact of cardiovascular disease on an infant extends from the fetal period to well beyond childhood. Perinatalogists and neonatologists can impact maternal and fetal health through wide range of diagnostic modalities and interventional techniques. For our edition focused on cardiovascular health, we sought to encompass the breadth of knowledge that would be the most relevant for the bed side clinician. Our goal was to assemble contents that would allow a clinician to quickly peruse the journal, and then be prepared to make a medical decision. The interaction between cardiology and perinatology/neonatology includes genetics, diagnostics, interventions, counseling, routine stabilization and day to day care. Ultimately, the goal is to establish the foundation for a healthy adult. For this reason, we have even included chapters on topics that are significant on a day to day basis (such as the proper environment for a newborn) and a long term basis (like the overall neurodevelopmental impact of our interventions). Hopefully, whether in the middle of the night as an emergency reference or during the day as a reliable guide, this edition of Clinics in perinatology will be an important bedside tool for anyone that participates in the care of a patient with perinatal heart disease.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Cardiovascular Disease | i | ||
| Copyright | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: The Journey to Adult Congenital Heart Disease\r | vii | ||
| Preface: Perinatal Cardiovascular Disease\r | vii | ||
| Risk Assessment and Management of the Mother with Cardiovascular Disease\r | vii | ||
| Fetal Diagnostics and Fetal Intervention\r | vii | ||
| Genetic and Developmental Basis of Cardiovascular Malformations\r | vii | ||
| Perinatal and Delivery Management of Infants with Congenital Heart Disease\r | viii | ||
| Screening for Critical Congenital Heart Disease\r | viii | ||
| Recognition of Undiagnosed Neonatal Heart Disease\r | viii | ||
| Fetal and Neonatal Arrhythmias\r | viii | ||
| Recent Advances in the Treatment of Preterm Newborn Infants with Patent Ductus Arteriosus\r | ix | ||
| Nutrition in the Cardiac Newborns: Evidence-based Nutrition Guidelines for Cardiac Newborns\r | ix | ||
| Developmental Care Rounds: An Interdisciplinary Approach to Support Developmentally Appropriate Care of Infants Born with C ... \r | ix | ||
| Management of the Preterm Infant with Congenital Heart Disease\r | ix | ||
| Neurodevelopmental Outcomes of the Child with Congenital Heart Disease\r | x | ||
| Pulmonary Hypertension and Pulmonary Vasodilators\r | x | ||
| CME Accreditation Page | xi | ||
| PROGRAM OBJECTIVE | xi | ||
| TARGET AUDIENCE | xi | ||
| LEARNING OBJECTIVES | xi | ||
| ACCREDITATION | xi | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | xi | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | xi | ||
| TO ENROLL | xii | ||
| METHOD OF PARTICIPATION | xii | ||
| CME INQUIRIES/SPECIAL NEEDS | xii | ||
| CLINICS IN PERINATOLOGY | xiii | ||
| FORTHCOMING ISSUES | xiii | ||
| June 2016 | xiii | ||
| September 2016 | xiii | ||
| December 2016 | xiii | ||
| RECENT ISSUES | xiii | ||
| December 2015 | xiii | ||
| September 2015 | xiii | ||
| June 2015 | xiii | ||
| Erratum | xv | ||
| Foreword:\rThe Journey to Adult Congenital Heart Disease | xvii | ||
| REFERENCES | xix | ||
| Preface:\rPerinatal Cardiovascular Disease | xxi | ||
| Risk Assessment and Management of the Mother with Cardiovascular Disease | 1 | ||
| Key points | 1 | ||
| MATERNAL MORTALITY: IMPACT OF CARDIOVASCULAR DISEASE | 2 | ||
| CONGENITAL HEART DEFECTS: REPAIRED, NOT CURED | 2 | ||
| PRECONCEPTION COUNSELING FOR THE WOMAN WITH CARDIOVASCULAR DISEASE | 2 | ||
| DETERMINING MATERNAL CARDIOVASCULAR RISK | 3 | ||
| Hemodynamic Changes in Normal Pregnancy | 3 | ||
| Maternal Risk Stratification | 3 | ||
| Assessment of Fetal Risk | 5 | ||
| Inheritance of congenital heart disease | 6 | ||
| Cardiac medications in pregnancy | 6 | ||
| Management of the woman with cardiovascular disease during pregnancy | 6 | ||
| MATERNAL CARDIOVASCULAR COMPLICATIONS OF PREGNANCY | 10 | ||
| Arrhythmias | 10 | ||
| Coronary Artery Disease | 10 | ||
| Heart Failure | 10 | ||
| Dilated cardiomyopathy | 10 | ||
| Development of heart failure during pregnancy | 10 | ||
| SPECIFIC CARDIAC CONDITIONS | 11 | ||
| Congenital Heart Disease | 11 | ||
| Prosthetic heart valves | 12 | ||
| Aortic stenosis | 13 | ||
| LABOR AND DELIVERY | 13 | ||
| Hemodynamic Changes of Labor and Delivery | 13 | ||
| Mode of Delivery | 14 | ||
| Anesthetics | 15 | ||
| IMPACT OF MATERNAL HEART DISEASE ON THE DEVELOPING FETUS | 15 | ||
| Genetic Counseling and Testing for Women with Congenital Heart Disease | 17 | ||
| SUMMARY | 18 | ||
| REFERENCES | 18 | ||
| Fetal Diagnostics and Fetal Intervention | 23 | ||
| Key points | 23 | ||
| INTRODUCTION | 23 | ||
| RATES OF FETAL DIAGNOSIS | 24 | ||
| OBSTETRIC SCREENING | 24 | ||
| FETAL ECHOCARDIOGRAPHY | 24 | ||
| Indications for Fetal Echocardiography | 24 | ||
| Timing of Fetal Echocardiogram | 24 | ||
| Equipment | 25 | ||
| COMPLETE FETAL ECHOCARDIOGRAM | 25 | ||
| SEQUENTIAL SEGMENTAL APPROACH | 27 | ||
| Fetal Position and Abdominal Arrangement | 27 | ||
| Atrial Arrangement | 28 | ||
| Atrioventricular Connections | 30 | ||
| Ventricular Arrangement | 30 | ||
| Ventriculoarterial Connections | 32 | ||
| Relationship of the Great Arteries | 33 | ||
| Additional Malformations | 33 | ||
| ASSESSMENT OF FETAL CARDIAC RHYTHM | 33 | ||
| LIMITATIONS OF FETAL ECHOCARDIOGRAPHY | 34 | ||
| FETAL INTERVENTIONS | 35 | ||
| Fetal Cardiac Catheterization | 35 | ||
| Fetal Surgery | 36 | ||
| SUMMARY | 37 | ||
| SUPPLEMENTARY DATA | 37 | ||
| REFERENCES | 37 | ||
| Genetic and Developmental Basis of Cardiovascular Malformations | 39 | ||
| Key points | 39 | ||
| INTRODUCTION | 39 | ||
| THE GENETIC BASIS OF CARDIOVASCULAR MALFORMATIONS | 40 | ||
| GENE DOSAGE AS A MECHANISM FOR CARDIOVASCULAR MALFORMATION | 41 | ||
| UNDERSTANDING THE GENETIC BASIS OF SYNDROMIC CARDIOVASCULAR MALFORMATION CAN IDENTIFY IMPORTANT GENES FOR ISOLATED CARDIOVA ... | 42 | ||
| BLURRING THE BOUNDARIES: SINGLE-GENE DEFECTS THAT CAN CAUSE BOTH SYNDROMIC AND ISOLATED CARDIOVASCULAR MALFORMATIONS | 43 | ||
| THE DEVELOPMENTAL BASIS FOR CARDIOVASCULAR MALFORMATIONS: GENES AND PATHWAYS REQUIRED FOR CRITICAL STAGES OF HEART FORMATION | 43 | ||
| PHENOTYPIC HETEROGENEITY AND LOCUS HETEROGENEITY | 46 | ||
| MUTATIONS IN DEVELOPMENTAL PATHWAYS MAY RESULT IN LATENT DISEASE | 47 | ||
| DECREASED PENETRANCE, VARIABLE EXPRESSIVITY, AND COMPLEX INHERITANCE: LESSONS FROM MOUSE MODELS | 48 | ||
| EPIGENETIC FACTORS IN CARDIOVASCULAR MALFORMATION | 48 | ||
| FUTURE DEVELOPMENTS | 49 | ||
| SUMMARY | 49 | ||
| What is the current practice? | 50 | ||
| Genetic Testing in Cardiovascular Malformations | 50 | ||
| Genetic Testing Options | 50 | ||
| What changes in current practice are likely to improve outcomes? | 50 | ||
| Is there a clinical algorithm? | 50 | ||
| Major Recommendations | 50 | ||
| Perinatal and Delivery Management of Infants with Congenital Heart Disease | 55 | ||
| Key points | 55 | ||
| INTRODUCTION | 55 | ||
| FETAL ECHOCARDIOGRAPHY AND RISK OF HEMODYNAMIC INSTABILITY AT BIRTH | 56 | ||
| Fetal and Transitional Circulation | 56 | ||
| Models of Risk Assessment of Hemodynamic Instability at Birth | 57 | ||
| Congenital heart disease without predicted risk of hemodynamic instability at birth | 57 | ||
| Congenital heart disease with minimal risk of hemodynamic instability at birth | 57 | ||
| Congenital heart disease with high risk of hemodynamic instability at birth | 60 | ||
| ANTENATAL FETAL SURVEILLANCE AFTER A DIAGNOSIS OF CONGENITAL HEART DISEASE | 63 | ||
| Cardiotocography and Biophysical Profile | 63 | ||
| Cardiovascular Profile Score | 63 | ||
| DELIVERY PLANNING FOR NEONATES PRENATALLY DIAGNOSED WITH CONGENITAL HEART DISEASE | 64 | ||
| Location of Delivery and Transportation of the Newborn | 64 | ||
| Timing of Delivery | 65 | ||
| Mode of Delivery | 65 | ||
| Fetal Surveillance During Labor | 65 | ||
| SUMMARY | 66 | ||
| SUPPLEMENTARY DATA | 67 | ||
| REFERENCES | 67 | ||
| What is the current practice? | 67 | ||
| What changes in current practice are likely to improve outcomes? | 67 | ||
| Major recommendations | 67 | ||
| Screening for Critical Congenital Heart Disease | 73 | ||
| Key points | 73 | ||
| INTRODUCTION | 73 | ||
| WHAT IS CRITICAL CONGENITAL HEART DISEASE SCREENING? | 73 | ||
| TECHNIQUE FOR CRITICAL CONGENITAL HEART DISEASE SCREENING | 75 | ||
| INTERPRETATION OF SCREENING RESULTS | 76 | ||
| The Positive Screen | 76 | ||
| The Negative Screen | 77 | ||
| SPECIAL SETTINGS | 77 | ||
| Neonatal Intensive Care Unit | 77 | ||
| High Altitude | 77 | ||
| Home Births | 78 | ||
| LIMITATIONS OF SCREENING | 78 | ||
| SUMMARY | 78 | ||
| What is the current practice? | 78 | ||
| Is there a clinical algorithm? | 78 | ||
| Summary statement | 78 | ||
| REFERENCES | 79 | ||
| Recognition of Undiagnosed Neonatal Heart Disease | 81 | ||
| Key points | 81 | ||
| INTRODUCTION | 81 | ||
| CONGENITAL HEART DEFECTS | 82 | ||
| Cyanosis | 83 | ||
| Differential diagnosis of neonatal cyanosis | 83 | ||
| First: the presence of respiratory distress | 83 | ||
| Second: the difference in cyanosis between the upper and lower body | 83 | ||
| Third: the response to oxygen | 85 | ||
| Congenital heart defects causing cyanosis | 85 | ||
| Decreased pulmonary blood flow | 85 | ||
| Aortic transposition over the venous ventricle (separated systemic and pulmonary circulations) | 86 | ||
| Distinguishing “decreased pulmonary blood flow” lesions from “separated circulations (aortic transposition)” | 87 | ||
| Differential pulse oximetry | 87 | ||
| Timing of cyanosis | 87 | ||
| Initial management for cyanotic heart disease | 88 | ||
| Hypoperfusion | 88 | ||
| Pathophysiologic processes | 89 | ||
| Congenital heart defects causing hypoperfusion | 89 | ||
| Left-sided obstruction | 89 | ||
| Hypoperfusion without obstruction | 90 | ||
| Initial management for hypoperfusion due to congenital cardiac disease | 91 | ||
| Respiratory Distress/Failure to Thrive | 92 | ||
| Pathophysiologic processes (and other considerations) | 92 | ||
| Congenital heart defects causing respiratory distress/failure to thrive | 93 | ||
| Left-to-right shunt alone | 93 | ||
| Bidirectional shunting with excessive pulmonary blood flow | 94 | ||
| Initial management of respiratory distress/failure to thrive lesions | 95 | ||
| Cardiovascular Examination | 96 | ||
| REFERENCES | 97 | ||
| Fetal and Neonatal Arrhythmias | 99 | ||
| Key points | 99 | ||
| INTRODUCTION | 99 | ||
| NORMAL IMPULSE GENERATION AND PROPAGATION | 99 | ||
| METHODS OF PERINATAL CARDIAC RHYTHM ASSESSMENT | 100 | ||
| MECHANISMS OF ARRHYTHMIAS | 100 | ||
| Abnormal Impulse Generation | 100 | ||
| Abnormal Impulse Propagation | 101 | ||
| CONSEQUENCES OF ARRHYTHMIAS | 101 | ||
| ASSESSMENT OF ARRHYTHMIAS | 102 | ||
| ARRHYTHMIAS PRESENTING WITH AN IRREGULAR RHYTHM | 103 | ||
| Premature Atrial Contractions | 103 | ||
| Premature Ventricular Contractions | 103 | ||
| ARRHYTHMIAS PRESENTING WITH A SLOW HEART RATE | 104 | ||
| Sinus Bradycardia | 104 | ||
| Complete Heart Block | 105 | ||
| Functional Atrioventricular Block | 106 | ||
| ARRHYTHMIAS PRESENTING WITH A FAST HEART RATE | 106 | ||
| Atrioventricular Reentrant Tachycardia and Atrial Flutter | 107 | ||
| Atrioventricular Reentrant Tachycardia | 107 | ||
| Atrial Flutter | 108 | ||
| Other | 109 | ||
| Atrial Ectopic Tachycardia | 110 | ||
| Ventricular Tachycardia | 110 | ||
| SUMMARY | 111 | ||
| REFERENCES | 111 | ||
| Recent Advances in the Treatment of Preterm Newborn Infants with Patent Ductus Arteriosus | 113 | ||
| Key points | 113 | ||
| INTRODUCTION | 113 | ||
| SYMPTOMS AND HEMODYNAMIC SIGNIFICANCE OF PATENT DUCTUS ARTERIOSUS | 114 | ||
| CURRENT TREATMENT OPTIONS FOR PATENT DUCTUS ARTERIOSUS OF PRETERM NEWBORN INFANTS | 115 | ||
| INTRAVENOUS INDOMETHACIN AND IBUPROFEN | 117 | ||
| Prophylactic Treatment | 117 | ||
| Symptomatic Treatment | 117 | ||
| ORAL IBUPROFEN | 117 | ||
| Effectiveness of Oral Ibuprofen | 117 | ||
| Adverse Events | 119 | ||
| Summary | 119 | ||
| PARACETAMOL (ACETAMINOPHEN) | 120 | ||
| Clinical Pharmacology | 120 | ||
| Oral Paracetamol | 120 | ||
| Intravenous Paracetamol | 121 | ||
| SURGICAL LIGATION AND CATHETER INTERVENTION OF HEMODYNAMICALLY SIGNIFICANT PATENT DUCTUS ARTERIOSUS | 122 | ||
| SUMMARY | 123 | ||
| REFERENCES | 124 | ||
| What is the current practice? | 124 | ||
| Persistently patent ductus arteriosus (PDA) of the preterm newborn infant | 124 | ||
| Major Recommendations | 124 | ||
| Best Practice/Guideline/Care Path Objective(s) | 124 | ||
| What changes in current practice are likely to improve outcomes? | 124 | ||
| Summary Statement | 124 | ||
| Nutrition in the Cardiac Newborns | 131 | ||
| Key points | 131 | ||
| NUTRITIONAL REQUIREMENTS IN NEONATES WITH CONGENITAL HEART DISEASE | 131 | ||
| PROTEIN STUDIES IN SICK/PRETERM NEONATES | 132 | ||
| NECROTIZING ENTEROCOLITIS IN CARDIAC NEWBORNS | 133 | ||
| NECROTIZING ENTEROCOLITIS IN PRETERM NEONATES WITH CONGENITAL HEART DISEASE | 134 | ||
| STANDARDIZED FEEDING PROTOCOLS | 136 | ||
| BREAST MILK STUDIES | 138 | ||
| INTESTINAL MICROBIOTA AND PROBIOTICS | 138 | ||
| POSTDISCHARGE NUTRITION AND GROWTH | 139 | ||
| NEED FOR GAVAGE FEEDING AT DISCHARGE | 140 | ||
| What is the current practice? | 141 | ||
| What changes in current practice are likely to improve outcomes? | 141 | ||
| Is there a Clinical Algorithm? | 141 | ||
| Summary statement | 141 | ||
| REFERENCES | 142 | ||
| Developmental Care Rounds | 147 | ||
| Key points | 147 | ||
| INTRODUCTION | 147 | ||
| COMPONENTS OF DEVELOPMENTAL CARE | 148 | ||
| Infant Care | 148 | ||
| Family-centered Care | 149 | ||
| INTERDISCIPLINARY DEVELOPMENTAL CARE ROUNDS | 149 | ||
| Clinical Nurse Specialist Role | 149 | ||
| Nurse Scientist Role | 150 | ||
| Occupational Therapist Role | 150 | ||
| Speech-Language Pathologist Role | 152 | ||
| Lactation Role | 152 | ||
| BARRIERS TO IMPLEMENTING DEVELOPMENTAL CARE | 154 | ||
| CASE EXAMPLE | 154 | ||
| Developmental Care Rounds: Week 1 | 154 | ||
| Developmental Care Rounds: Week 2 | 154 | ||
| Developmental Care Rounds: Week 3 | 155 | ||
| SUMMARY | 155 | ||
| What is the current practice? | 155 | ||
| What changes in current practice are likely to improve outcomes? | 155 | ||
| Summary statement | 155 | ||
| REFERENCES | 156 | ||
| Management of the Preterm Infant with Congenital Heart Disease | 157 | ||
| Key points | 157 | ||
| INTRODUCTION | 157 | ||
| TIMING OF DELIVERY AND OBSTETRIC CONSIDERATIONS | 158 | ||
| PREOPERATIVE CONSIDERATIONS | 159 | ||
| Timing of Cardiac Surgery | 159 | ||
| Specific Lesions in the Premature Neonate | 161 | ||
| Coarctation of the aorta | 161 | ||
| Transposition of the great arteries | 162 | ||
| Hypoplastic left heart syndrome | 162 | ||
| Aortic arch obstruction (2-ventricle surgical repair) | 162 | ||
| Tetralogy of Fallot | 163 | ||
| Postoperative Considerations | 163 | ||
| OUTCOMES: MORTALITY AND COMMON COMPLICATIONS OF PREMATURITY | 164 | ||
| Bronchopulmonary Dysplasia | 164 | ||
| Sepsis | 164 | ||
| Necrotizing Enterocolitis | 165 | ||
| Intraventricular Hemorrhage and Periventricular Leukomalacia | 165 | ||
| Retinopathy of Prematurity | 165 | ||
| Neurodevelopmental Outcomes and Follow-up Needs | 165 | ||
| SUMMARY | 166 | ||
| What is the current practice? | 166 | ||
| What changes in current practice are likely to improve outcomes? | 166 | ||
| Summary statement | 166 | ||
| REFERENCES | 167 | ||
| Neurodevelopmental Outcomes of the Child with Congenital Heart Disease | 173 | ||
| Key points | 173 | ||
| INTRODUCTION | 173 | ||
| GENETIC COMORBIDITY | 174 | ||
| PERIOPERATIVE NEUROLOGIC FINDINGS | 175 | ||
| Clinical Examination and Electrocardiogram | 175 | ||
| Neuroimaging | 176 | ||
| DOMAINS OF NEURODEVELOPMENTAL IMPAIRMENTS | 176 | ||
| Early Childhood | 177 | ||
| Long-Term Outcome | 178 | ||
| Predictors of Neurodevelopmental Outcome | 179 | ||
| CLINICAL IMPLICATIONS | 179 | ||
| SUMMARY/DISCUSSION | 181 | ||
| REFERENCES | 182 | ||
| Pulmonary Hypertension and Pulmonary Vasodilators | 187 | ||
| Key points | 187 | ||
| INTRODUCTION | 187 | ||
| DEFINITIONS AND CRITERIA FOR DIAGNOSIS OF PULMONARY HYPERTENSION | 188 | ||
| Invasive Assessment of Pulmonary Hypertension: the Gold Standard | 188 | ||
| Clinical Assessment of Pulmonary Hypertension | 189 | ||
| Echocardiographic Assessment of Pulmonary Hypertension | 190 | ||
| Echocardiography and the assessment of cardiovascular comorbidities | 192 | ||
| THERAPIES FOR PULMONARY HYPERTENSION: ACUTE AND CHRONIC | 192 | ||
| Treatment of Persistent Pulmonary Hypertension of the Newborn | 193 | ||
| Preterm Infants with Persistent Pulmonary Hypertension of the Newborn | 194 | ||
| Chronic Therapies for Perinatal Pulmonary Hypertension | 194 | ||
| Phosphodiesterase inhibitors: sildenafil | 195 | ||
| Endothelin receptor antagonists: bosentan | 195 | ||
| Prostacyclin and its analogues | 197 | ||
| SUMMARY | 197 | ||
| REFERENCES | 198 | ||
| What is the current practice? | 198 | ||
| Is there a clinical algorithm? | 198 | ||
| Summary statement | 198 | ||
| Index | 203 |