| What factor can lead to differences in how an individual patient is managed? | his/her specific condition, as decided by the treating physician | This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. Kindly visit the website of ICMR for more information: (icmr.gov.in) for more information. ©Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India. | 325 | relationship | 0.970 | There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. | 1 | page=1,block=1 | 0.700 | valid |
| What does the abbreviation AS represent in relation to congenital heart disease? | Aortic Stenosis | Heart Failure Look for Tachypnoea, Tachycardia, Tender Hepatomegaly Is the baby sucking from the Feeding Normal: sucking vigorously, no suck rest suck breast breast normally? cycle, no breathlessness/ forehead sweating while feeding, no prolonged feeding times AS: Aortic Stenosis L->R: Left to Right PV: Pulmonary Valve TV: Tricuspid Valve AV: Aortic Valve MV: Mitral Valve TAPVC: Total anomalous pulmonary VSD: Ventricular Septal CCHD: Cyanotic Congenital Heart Disease PA: Pulmonary Artery Venous Connection Defect CHD: Congenital Heart Disease PG E1: Prostaglandin E1 TGA: Transposition of Great Arteries HLHS: Hypoplastic Left Heart Syndrome PS: Pulmonary Stenosis TOF: Tetralogy of Fallot 1. Gupta SK. Congenital heart disease. In Agarwal R, Deorari A, Paul V, Sankar MJ, Sachdeva A (Eds), AIIMS protocols in Neonatology. Noble Vision Medical Books Publishers, New Delhi 2019. Page 150-164 2. | 265 | definition | 0.940 | Heart Failure Look for Tachypnoea, Tachycardia, Tender Hepatomegaly Is the baby sucking from the Feeding Normal: sucking vigorously, no suck rest suck breast breast normally? cycle, no breathlessness/ forehead sweating while feeding, no prolonged feeding times AS: Aortic Stenosis L->R: Left to Right PV: Pulmonary Valve TV: Tricuspid Valve AV: Aortic Valve MV: Mitral Valve TAPVC: Total anomalous pulmonary VSD: Ventricular Septal CCHD: Cyanotic Congenital Heart Disease PA: Pulmonary Artery Venous Connection Defect CHD: Congenital Heart Disease PG E1: Prostaglandin E1 TGA: Transposition of Great |
| What symptoms should be checked for in a baby to identify heart failure? | Tachypnoea, Tachycardia, Tender Hepatomegaly | Heart Failure Look for Tachypnoea, Tachycardia, Tender Hepatomegaly Is the baby sucking from the Feeding Normal: sucking vigorously, no suck rest suck breast breast normally? cycle, no breathlessness/ forehead sweating while feeding, no prolonged feeding times AS: Aortic Stenosis L->R: Left to Right PV: Pulmonary Valve TV: Tricuspid Valve AV: Aortic Valve MV: Mitral Valve TAPVC: Total anomalous pulmonary VSD: Ventricular Septal CCHD: Cyanotic Congenital Heart Disease PA: Pulmonary Artery Venous Connection Defect CHD: Congenital Heart Disease PG E1: Prostaglandin E1 TGA: Transposition of Great Arteries HLHS: Hypoplastic Left Heart Syndrome PS: Pulmonary Stenosis TOF: Tetralogy of Fallot 1. Gupta SK. Congenital heart disease. In Agarwal R, Deorari A, Paul V, Sankar MJ, Sachdeva A (Eds), AIIMS protocols in Neonatology. Noble Vision Medical Books Publishers, New Delhi 2019. Page 150-164 2. | 23 | list | 0.740 | Heart Failure Look for Tachypnoea, Tachycardia, Tender Hepatomegaly Is the baby sucking from the Feeding Normal: sucking vigorously, no suck rest suck breast breast normally? cycle, no breathlessness/ forehead sweating while feeding, no prolonged feeding times AS: Aortic Stenosis L->R: Left to Right PV: Pulmonary Valve TV: Tricuspid Valve AV: Aortic Valve MV: Mitral Valve TAPVC: Total anomalous pulmonary VSD: Ventricular Septal CCHD: Cyanotic Congenital Heart Disease PA: Pulmonary Artery Venous Connection Defect CHD: Congenital Heart Disease PG E1: Prostaglandin E1 TGA: Transposition of Great |
| What are the guidelines in the STW based on? | expert opinions and available scientific evidence | This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. Kindly visit the website of ICMR for more information: (icmr.gov.in) for more information. ©Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India. | 198 | factual | 0.570 | These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. | 1 | page=1,block=1 | 0.700 | valid |
| Where can additional details about the STW be accessed? | the website of ICMR for more information: (icmr.gov.in) | This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. Kindly visit the website of ICMR for more information: (icmr.gov.in) for more information. ©Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India. | 468 | factual | 0.570 | Kindly visit the website of ICMR for more information: (icmr.gov.in) for more information. | 1 | page=1,block=1 | 0.700 | valid |
| Which entity is responsible for the creation of the STW? | Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India | This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. Kindly visit the website of ICMR for more information: (icmr.gov.in) for more information. ©Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India. | 547 | factual | 0.570 | ©Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India. | 1 | page=1,block=1 | 0.700 | valid |
| What could cause cyanosis during the first week of life? | dTGA with intact ventricular septum | Onset of cyanosis Possible CHD dTGA with intact ventricular septum Hypoplastic left heart or right heart Tricuspid atresia/critical stenosis of 1st week (Day 1 to 7) PV, MV, AV TOF (severe) or pulmonary atresia TAPVC Truncus arteriosus Ebstein’s anomaly Hypoplastic left heart dextro-Transposition of the Great 7 days to 1 month Arteries (dTGA) TOF Severe PS Truncus arteriosus TOF Double outlet right ventricle (DORV) Late onset cyanosis with VSD - PS, dTGA with VSD -PS, Tricuspid atresia with VSD -PS Hemodynamic approach to CHDs Duct dependent systemic circulation (Critical AS, HLHS Severe Interrupted aortic arch) Hypotension/shock Ventricular dysfunction Arrhythmia with hemodynamic compromise Decreased pulmonary blood flow (duct dependent pulmonary circulation): Pulmonary Atresia, Critical PS Severe desaturation TOF with severe PS Ebstein’s anomaly Increased PBF & high PA pressure: Transposition Pulmonary plethora: L -> R shunt With cyanosis/desaturation - CCHD with Heart failure increased pulmonary blood flow (PBF) With severe desaturation and pulmonary venous hypertension: Obstructed TAPVC Intravenous/Intraosseous access and fluid resuscitation 10 ml per kg of isotonic fluid, (max 40 ml per kg until perfusion improves or hepatomegaly develops). | 31 | factual | 0.570 |
| What is a condition associated with late-onset cyanosis and VSD? | Tricuspid atresia with VSD -PS | Onset of cyanosis Possible CHD dTGA with intact ventricular septum Hypoplastic left heart or right heart Tricuspid atresia/critical stenosis of 1st week (Day 1 to 7) PV, MV, AV TOF (severe) or pulmonary atresia TAPVC Truncus arteriosus Ebstein’s anomaly Hypoplastic left heart dextro-Transposition of the Great 7 days to 1 month Arteries (dTGA) TOF Severe PS Truncus arteriosus TOF Double outlet right ventricle (DORV) Late onset cyanosis with VSD - PS, dTGA with VSD -PS, Tricuspid atresia with VSD -PS Hemodynamic approach to CHDs Duct dependent systemic circulation (Critical AS, HLHS Severe Interrupted aortic arch) Hypotension/shock Ventricular dysfunction Arrhythmia with hemodynamic compromise Decreased pulmonary blood flow (duct dependent pulmonary circulation): Pulmonary Atresia, Critical PS Severe desaturation TOF with severe PS Ebstein’s anomaly Increased PBF & high PA pressure: Transposition Pulmonary plethora: L -> R shunt With cyanosis/desaturation - CCHD with Heart failure increased pulmonary blood flow (PBF) With severe desaturation and pulmonary venous hypertension: Obstructed TAPVC Intravenous/Intraosseous access and fluid resuscitation 10 ml per kg of isotonic fluid, (max 40 ml per kg until perfusion improves or hepatomegaly develops). | 473 | factual | 0.570 |
| What factors might indicate the presence of septic shock? | Predisposing maternal and neonatal factors | Manage Hypothermia, Hypoglycemia, hypocalcemia Appropriate antibiotic Monitoring to assess response Manage shock as per Neonatal shock guidelines Septic shock likely if: • Predisposing maternal and neonatal factors • Core peripheral temperature difference > 3 • Sepsis Screen Positive Start PG E1 and refer if: • Identifiable that femoral pulses are distinctly feeble compared to upper body • Right arm - Any foot SpO2 difference more than 3% Low threshold for Paediatric Cardiology Evaluation Refractory Shock, Unlikely to be sepsis - Urgent referral to Pediatric Cardiologist Shock APPROACH TO SHOCK APPROACH TO CYANOSIS Cyanosis (<SpO2<95%) Rule out TAPVC SpO2 < 80%? | 172 | factual | 0.570 | Manage Hypothermia, Hypoglycemia, hypocalcemia Appropriate antibiotic Monitoring to assess response Manage shock as per Neonatal shock guidelines Septic shock likely if: • Predisposing maternal and neonatal factors • Core peripheral temperature difference > 3 • Sepsis Screen Positive Start PG E1 and refer if: • Identifiable that femoral pulses are distinctly feeble compared to upper body • Right arm - Any foot SpO2 difference more than 3% Low threshold for Paediatric Cardiology Evaluation Refractory Shock, Unlikely to be sepsis - Urgent referral to Pediatric Cardiologist Shock APPROACH TO |
| When should SpO2 be closely monitored in newborns? | through first week of life (for decrease in SpO2 on ductal closure) | Early Paediatric Cardiology Consultation & Echo Late discharge once diagnosis confirmed Close SpO2 monitoring through first week of life (for decrease in SpO2 on ductal closure) Heart Failure Management (if only clinical features of CHF) Iron supplementation Duct dependent pulmonary circulation (All forms of Pulmonary Atresia/Critical PS) TGA with intact septum Start PGE1 infusion refer for urgent paediatric cardiology evaluation (within hours) SpO2<80% On serial monitoring Chest X-ray S/O whiteout lung/ Ground glass appearance /pulmonary venous hypertension If clinical setting makes it unlikely to be Respiratory distress syndrome, | 110 | factual | 0.570 | Early Paediatric Cardiology Consultation & Echo Late discharge once diagnosis confirmed Close SpO2 monitoring through first week of life (for decrease in SpO2 on ductal closure) Heart Failure Management (if only clinical features of CHF) Iron supplementation Duct dependent pulmonary circulation (All forms of Pulmonary Atresia/Critical PS) TGA with intact septum Start PGE1 infusion refer for urgent paediatric cardiology evaluation (within hours) SpO2<80% On serial monitoring Chest X-ray S/O whiteout lung/ Ground glass appearance /pulmonary venous hypertension If clinical setting makes it |