Neonatal Cardiology

Neonatal Cardiology - Diagnosis and Management of the...

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Diagnosis and Management of Diagnosis and Management of the Neonate With Critical the Neonate With Critical Congenital Heart Disease Congenital Heart Disease Department of Pediatrics National Naval Medical Center 15 April 03
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Neonate With Critical CHD Neonate With Critical CHD Prenatal evaluation Initial neonatal evaluation and management Stabilization and transport Confirmation of the diagnosis Preoperative evaluation of non-cardiac organ systems Timing and type of surgery Lesion specific management
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Prenatal Assessment Prenatal Assessment Obstetric history Genetic evaluations Prenatal ultrasound Fetal echocardiography 60% of cardiology admissions at CHOP prenatally diagnosed 49% of HLHS admissions at Children’s Hospital of Wisconsin were prenatally diagnosed
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Normal Fetal Echocardiogram: Four Chamber View Normal Fetal Echocardiogram: Four Chamber View
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Ebstein’s Anomaly Ebstein’s Anomaly
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Critical CHD: Initial Evaluation and Critical CHD: Initial Evaluation and Management Management ABC’s Oxygen (judicial) to saturations of 80-85% Place umbilical lines PGE (0.025-0.1 micrograms/Kg/min) History Complete physical with four extremity BP’s Pre and post-ductal oxygen saturations Hyperoxia test CXR EKG Echocardiogram
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Suspected CHD: Initial Evaluation Suspected CHD: Initial Evaluation and Management and Management Pre and post-ductal oxygen saturations If pre-ductal sat higher than post-ductal sat (differential cyanosis) Left heart abnormalities (such as aortic arch hypoplasia, critical aortic stenosis, interrupted aortic arch) Persistent pulmonary hypertension If post-ductal sat higher than pre-ductal (reverse differential cyanosis) TGA with CoA or TGA with IAA TGA with supersystemic pulmonary vascular resistance
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Stabilization and Transport Stabilization and Transport ABC’s Place lines (UVC, UAC)
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Neonatal Cardiology - Diagnosis and Management of the...

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