CCF in Neonates Dr Rajesh Kumar MD (PGI), DM (Neonatology - PowerPoint PPT Presentation

Loading...

PPT – CCF in Neonates Dr Rajesh Kumar MD (PGI), DM (Neonatology PowerPoint presentation | free to download - id: 3e1cae-OWZlN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

CCF in Neonates Dr Rajesh Kumar MD (PGI), DM (Neonatology

Description:

CCF in Neonates Dr Rajesh Kumar MD (PGI), DM (Neonatology) PGI, Chandigarh, India Rani Children Hospital, Ranchi Aim What are the causes of CCF in neonate? – PowerPoint PPT presentation

Number of Views:213
Avg rating:3.0/5.0
Slides: 42
Provided by: ranichildr
Learn more at: http://ranichildrenhospital.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: CCF in Neonates Dr Rajesh Kumar MD (PGI), DM (Neonatology


1
CCF in Neonates
  • Dr Rajesh Kumar
  • MD (PGI), DM (Neonatology) PGI, Chandigarh, India
  • Rani Children Hospital, Ranchi

2
Aim
  • What are the causes of CCF in neonate?
  • How to diagnose CCF in a neonate?
  • What are the different investigations required?
  • What is the treatment?

3
Definition
  • Heart is unable to meet the metabolic demands of
    the tissues

4
Stress on heart
HR
  • Contractility
  • catecholamine
  • autonomic input
  • Preload
  • renal preservation
  • venous constriction

Decompesation
HR Pul edema, hepatomegaly
Cardiac output
5
Diagnosis of CCF
  • Clinical
  • Radiographic findings
  • Laboratory findings

6
Signs and symptoms of CCF
  • Tachycardia
  • Venous congestion
  • Right side
  • Hepatomegaly
  • Ascitis
  • Pleural effusion
  • Edema
  • Left side
  • Tachypnea
  • Retactions
  • Crepitations
  • Pul. edema
  • Low cardiac output
  • Acute
  • Pallor
  • Sweating
  • Cool extremities
  • capillary refill
  • Altered sensorium
  • Chronic
  • Feeding difficulty
  • Fatigue
  • Poor growth

7
Diagnosis of CCF X-ray
  • To rule out primary pulmonary disease
  • Magnitude of pulmonary blood flow
  • Cardiac size
  • Cardiac shape (boot shaped, egg on side, snow
    man)

8
(No Transcript)
9
Diagnosis of CCF ECG
  • More useful in D/D of cyanotic newborn with pul
    blood flow

-90
Tricuspid atresia
0
180
Pul atresia with intact vent septum
TOF, Pul stenosis
90
10
Diagnosis of CCF Echo
  • Rules out associated significant heart disease in
    pt with pulmonary disease
  • Doppler echo is preffered
  • Operator dependant
  • Examination of extracardiac structure is limited

11
Diagnosis of CCF Cardiac catheterisation
  • Necessary to delineate vascular anatomy before
    surgery in some cases

12
Causes of CCF
  • Cardiac
  • Structural
  • Arrythmia
  • Myocardial dysfunction
  • Extracardiac compression
  • Non-cardiac
  • Preload (ARF)
  • Afterload (HT)
  • O2 carrying capacity (anemia)
  • Demand (sepsis)

13
(No Transcript)
14
Case study
  • Term newborn well for first 2-3 hours, developed
    respiratory distress, gradually worsening
  • CPAP for 3 days, gradually improved but continues
    to have problem, Day 1 echo ?? coarct
  • Day 5 echo showed significant coarct
  • Dischraged on day 7, worsened in next 4-5 days
  • Operated for coarct at day 25 of life, now (5
    months) doing well

15
Case study
  • 33 weeks, infant of diabetic mother
  • Had respiratory distress since birth, suspected
    to have HMD, had murmur
  • Echo showed PDA with Co-actation of aorta
  • Medical management tried, Surgery done in third
    week, Now asymptomatic

16
(No Transcript)
17
Causes of CCF Cardiac-structural heart disease
  • Left ventricular outflow tract obstruction
  • Aortic stenosis, co-arctation of aorta
  • Ductus dependant lesions
  • Critical aortic stenosis, preductal coarctation
    of aorta, interrupted aortic arch, hypoplastic
    left heart syndrome, TGA
  • Left to right shunt
  • VSD, PDA, ASD
  • Regugitant lesions
  • ECD, truncus arterioisus

18
Case study
  • Term newborn, Wt 3.0 Kg
  • Antenataly suspected congenital heart block
  • At birth heart rate 50 per minute, Echo normal,
    ECG s/o CHB
  • Developed tachypnea and retraction on day 3
  • Required temporary pacing followed by permament
    pace maker implant
  • Well till 1 year of life

19
(No Transcript)
20
Causes of CCF Cardiac-arrythmia
  • Congenital heart block
  • Supraventricular tachycardia
  • Ventricular tachycardia

21
Causes of CCF Cardiac-myocardial dysfunction
  • Cardiomyopathy
  • Perinatal asphyxia
  • Myocardial infarction
  • Sepsis
  • Acute LVF

22
Treatment
  • Treatment of underlying cause
  • Reversing metabolic derangements
  • Improving cardiac performance
  • Altering preload / afterload burden
  • Improved oxygen delivery
  • Enhanced nutrition

23
Improving cardiac performance
  • Sympathomimetics
  • Dopamine
  • Dobutamine
  • Phenylephrine
  • Adrenaline, Noradrenaline
  • Phosphodiasterase inhibitors
  • Amrinone, Minrinone
  • Digoxin

24
Dopamine
  • Naturally acting catecholamine
  • Low dose direct stimulation of dopamine
    receptors, higher dose works through release of
    norepinephrine
  • Premature babies require lesser dose than term
    babies
  • Dose (mg/kg/min) Effects
  • 1-5 HR, UOP, contractility
  • 5-10 HR, contractility, BP
  • 10-20 HR, contractility, BP, SVR

25
Dopamine
  • 40 mg per ml (1mg per unit by insuline syringe)
  • Neonate
  • In Pediadrip set
  • 2mg /kg/ 6hrs fluid (5.5 mg/kg/min) to
    6mg/kg/6hours fluid
  • By infusion pump
  • 15 mg (15 units) dopamine 50 ml NS, Infuse _at_
    1ml/kg/hour ( 5mg/kg/min) to 4 ml/kg/hour

26
Dobutamine
  • 50 mg per ml (1.25mg per unit by insuline
    syringe)
  • Neonate
  • In Pediadrip set
  • 2mg /kg/ 6hrs fluid (6.87 mg/kg/min) to
    6mg/kg/6hours fluid
  • By infusion pump
  • 15 mg (15 units) dopamine 50 ml NS, Infuse _at_
    1ml/kg/hour ( 6.87 mg/kg/min) to 4 ml/kg/hour

27
Dobutamine
  • Synthetic catecholamine
  • Does not depend on NE stores
  • Effects contractility, SVR, HR
  • Often used with dopamine to contractility and
    to avoid extreme vasoconstriction associated with
    high dose dopamine

28
Amrinone
  • Positive inotropy Vasodilator
  • Can be combined with sympathomimetics
  • Precautions not in hypovolumic, not in pt with
    fixed systemic outflow tract obstruction
  • Dose
  • Neonate loading 3-4.5 mg/kg, folowwed by
    infusion of 3-5 mg/kg/min
  • Infant loading 3-4.5 mg/kg, folowwed by
    infusion of 10 mg/kg/min

29
Amrinone
  • 5 mg per ml, 20 ml ampoule, dilute only with
    saline, never with dextrose
  • Neonate
  • 10mg (2ml) NS 48 ml
  • Infuse _at_ 1ml/kg/hr (3.3 mg/kg/min) to 1.5ml/kg/hr
  • Infant
  • 30mg (6ml) NS 44 ml
  • Infuse _at_ 1ml/kg/hr (10 mg/kg/min)

30
Epinephrine
  • myocardial contractility, SVR
  • Useful in sepsis induced cardiac failure as
    second or third line drug
  • Dose Starting- 0.05-0.1 mg/kg/min can be
    rapidly
  • Preparation 0.3ml(12 units) 50 ml NS, Start
    with ML in kg /hr (0.1 mg/kg/min ) and then
    increase

31
Digoxin
  • Inotropic agent
  • Loading dose
  • Premature neonate20-30 mg/kg
  • Term neonate 30-40 mg/kg
  • Schedule for loading ½, ¼, ¼ 8hours apart
  • Maintanance dose
  • Premature neonate 5-10 mg/kg/day BD
  • Term neonate 10 mg/kg/day BD

32
Digoxin
  • Route IV, IM, oral
  • Injection 1ml ampoule, 250 mg /ml
  • 1unit 6.25 mg 10 mg /kg 1.5units/kg
  • Oral (Digoxin Paed elixir) 1ml 0.05 mg
  • Maintenance dose 0.01 mg/kg/day
  • Wt in kg /10 ml twice daily
  • 3 kg 0.3 ml twice daily

33
Alteration of preload
  • Fluid retention due to low cardiac output and
    renal perfusion
  • Ventricular contractility is compromised due to
    massive volume overload
  • Diuretics
  • Acute diuresis Furosemide 1-4 mg/kg/dose
  • Chronic diuresis Furosemide potassium sparing
    diuretics

34
Alteration of afterload
  • Precaution Do not use in hypovolumic condition
    and in pt with fixed left ventricular outflow
    obstruction
  • Effective in Regurgitant lesions(ECD,
    Cardiomyopathy) and left to right shunts (VSD)
  • Acute Nitroprusside, Dobutamine, amrinone
  • Chronic ACE inhibitors
  • Enalapril 0.1 mg/kg /day OD or BD ( 5 kg ¼ tab
    OD)

35
Prostaglandin E1
  • Useful in ductal dependant CHD
  • Best before 96 hours after birth
  • Dose 0.5 0.2 mg/kg/minute
  • Presentation ALPOSTIN, 1 ml ampoule, 1ml500mg
  • C/I PFC, infradiafragmatic TAPVC
  • Side effects Apnea

36
Correction of metabolic derangements
  • Correct metabolic acidosis
  • 2 ml/kg bolus, later by ABG report
  • Correct hypoglycemia
  • 2 ml/kg of 10 dextrose
  • Correct hypocalcemia
  • 2 ml/kg calicium gluconate over 5 minutes

37
Improved oxygen delivery
  • Oxygen content of blood
  • Hb X saturation X 13.6 0.0031 X PaO2
  • Start oxygen
  • Blood transfusion if HB lt10-13 gm
  • Iron supplementation

38
PDA in premature babies
  • Prophylactic indomethacin or ibuprofen in lt1500
    gms and lt 34 weeks
  • Fluid restriction
  • Diuretics lasix
  • Therapeutic
  • Indomethacin 0.2 mg/kg per dose 8 hourly three
    doses
  • Ibuprofen 5-10 mg/kg per dose 8 hourly three
    doses

39
Summary
  • Treat metaboloic derangements aggresively
  • Get echo done whenever in doubt
  • Many of the structural heart disease is treatable
    is our setup

40
Thank You
41
Thank you
About PowerShow.com