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All you want to know about the congenital heart disease which is a very common child heart birth defect is in this presentation. On an average every 1 in 100 pregnancy in India is affected by congenital heart disease. The disease is present by birth in children as heart defect. – PowerPoint PPT presentation

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What is Congenital Heart Disease?
  • It is a defect in the structure of the heart of
    the baby.
  • This is the most common birth defect. 1 in 100
    children are born with this problem.
  •  Defect in the heart may involve walls of the
    heart, values, arteries and veins of the heart.
    The defects may cause disruption, slowing down
    and going in wrong direction of place of the
  • 1,80,000 children to 2,00000 are born with this
    problem each year in our country.
  • Out of these only 10-15,000 end up getting
    treated, rest either do not survive or get added
    to pool of wait listed children in Govt.
  • Of the 240,000 children born with CHD each year
    in India, about one fifth would need early
    intervention to survive the first year of life.

Types of CHD
  • 4 types are majorly known.
  • Ventricular Septal Defects(VSD) Hole in the wall
    separating the two lower chambers of heart.
  • Atrial Septal Defects(ASD) Hole in the wall
    separating the two upper chambers of heart.
  • Patent Ductus Arteriosus(PDA) Open hole in the
  • Tetralogy of Fallot(TOF) Collection of 4
    abnormalities major one deviation of a part of
    upper wall of the hole which obstructs blood
    going to the lungs.

Signs and Symptoms of CHD
  • Bluish tinge or color (cyanosis) to the skin
    around the mouth or on the lips, tongue and
  • Increased rate of breathing and difficulty in
  • Poor appetite or difficulty in feeding.
  • Sweating while feeding.
  • Failure to gain weight or weight loss.
  • Unexplained fever with decreased energy or
    activity level.

Diagnosis Treatment of the CHD
  • Some CHDs may be diagnosed during pregnancy
    using fetal echocardiography (a special type of
    ultrasound in which ultrasound pictures of the
    heart of a developing baby is captured ).
  • Some CHDs are not detected until after birth or
    later in life during childhood or adulthood.
  • If a pediatrician suspects a CHD the baby is
    referred to a pediatric cardiologist and get
    tests like fetal echo to confirm the diagnosis.
  • Treatment for CHD children depends on the type
    and severity of the heart defect. Some children
    might need one or more surgeries to repair the
    heart or blood vessels. Some can be treated
    without surgery using a procedure called cardiac
  • Many times it happens that heart defect cant be
    fully repaired but blood flow and the working of
    the heart improves a lot.

Present Condition of CHD Treatment in India
  • The total number of cardiac centres approximates
    to 63.
  • 10 of these can be considered high volume
    centres (more than 500 cardiac surgeries per
  • Approx 27,000 patients with CHD underwent cardiac
    surgery over a one-year period (2016-2017).
  • Of this, about 9,700 patients were infants (lt1
    year), and about 1700 were neonates (lt1 month).
  • Considering the birth prevalence of serious CHD
    (requiring intervention in first year of life) as
    1.6/1000 live births, about 43,000 babies are
    born in India every year with serious CHD,
  • Only about one-fourth seem to be receiving
    optimal cardiac care. This proportion, though
    still very low.

Regional Disparity
  • 47 Centres in India are located in regions with
    lower burden of CHD.
  • States such as Uttar Pradesh, Bihar, Jharkhand
    and Madhya Pradesh, which presumably have much
    higher CHD burden as compared to the rest of
    states, have fared much worse.
  • The data suggest that children born with serious
    CHD in Southern India have a 70 chance of
    receiving good treatment.
  • In contrast, babies born in Eastern and Central
    parts of India have a much lower chance of
    receiving an intervention.
  • Although we have newly opened government
    institutes (All India Institute of Medical
  • These institutes are already operational in
    various states, including those in eastern,
    central and northern parts of India.
  • The patient load is very high.

Regional Variation in India
Source https//www.indianpediatrics.net/
Obstacles for Pediatric Cardiac Care in India
  • A substantial proportion of births in India occur
    at home, and the infant is likely to die before
    the critical, ductus-dependent CHD is diagnosed.
  • The resources for treatment of CHD are not only
    inadequate but also seriously mal-distributed.
  • Investment on healthcare is one of the lowest in
  • There is no national policy for CHD.
  • Rapid population growth, competing priorities,
    inefficient and inadequately equipped
  • Lack of awareness and delay in diagnosis 
  • Maldistribution of resources
  • Deficit of trained staff at all levels of
  • No Strategies for Improvement of Cardiac Care

Obstacles for Pediatric Cardiac Care in India
  • Children undergoing surgery are often in advanced
    stages of disease with associated malnutrition,
    the results of intervention in such settings are
    expected to be less than ideal.
  • Poverty
  • Transport of new-borns and infants with CHD
  • Most cardiac centres, especially those set-up
    more recently, are in the private sector and may
    not be affordable for the majority.
  • Public hospitals are faced with a very large
    number of patients and have waiting lists ranging
    from months to years.
  • The greatest barrier to successful treatment of
    CHD is more common in states with little or no
    cardiac care facilities.
  • There is practically no organized system for safe
    transport, The risks of developing hypothermia
    and hypoglycaemia during long, unsupervised
    transport further adds to the already serious
    condition of the infants with CHD of new-borns.

Obstacles for Pediatric Cardiac Care in India
  • Financial constraints
  • There is no national policy for CHD. Rapid
    population growth, competing priorities,
    inefficient and inadequately equipped
    infrastructure, and a deficit of trained staff at
    all levels of healthcare are some of the other
    major roadblocks to cardiac care of children with
  • Medical insurance is practically non existent in
    India, especially for birth defects. In most
    instances, families are expected to pay for the
    treatment out of their pocket, which they can
    barely afford.
  • Many families lose their wages as they are away
    from work during care of these children.

Strategies for Better Care
  • To make meaningful reductions in mortality and
    morbidity from CHD, it is imperative to focus on
    comprehensive new-born and infant cardiac care.
  • Preventive measures and screening So far, little
    emphasis has been placed on preventive measures
    for CHD. Mass immunization against Rubella should
    be the starting point at the national level.
  • Increasing awareness Community needs to be
    sensitized to the problem of congenital defects,
    through electronic and print media.
  • Targeting Pediatricians and educating them not
    just about diagnosing CHD in a new-born, but also
    about the advancements that have occurred in the
    care of children with CHD should also be helpful.

How to Overcome the Challenges
  • Optimal utilization of resources.
  • Currently India has approximately 130 pediatric
    cardiologists and 110 pediatric cardiac surgeons
    which is very less.
  • Increase the training programs for paediatricians
    for early diagnosis.
  • One of the successful schemes adopted by
    Karnataka Govt, called Yeshashwini, is a
    microfinance scheme where each member of a
    cooperative group pays a nominal amount to create
    a corpus which is used to fund surgeries

How to Overcome the Challenges
  • Several other states have similar schemes under
    different names. A number of initiatives by the
    central government are directed at health of
  • Provision is also provided for free treatment of
    children from families which are below poverty
  • Poor patients can get financial help from Prime
    Ministers Relief Fund and Chief Ministers
    Relief Fund. The policy makers and others in the
    government are taking note of pediatric health,
    and in future, we may see more schemes for the
    benefit of children with CHD. However, we must
    have the infrastructure to take care of this
    increasing demand.

How to Overcome the Challenges
  • Indigenization and innovation
  • For cardiac surgery and interventions to be
    affordable, cost-containment is necessary.
    Currently, majority of equipment and disposable
    items required for cardiac surgery are being
    imported. Encouraging home grown technology will
    reduce the cost of equipment considerably.
  • Providing financial support for treatment A
    number of financial models are supporting
    healthcare in India. Many of them cater to
    children and cover for CHDs.

Strategy for Cardiac Care
  • A flagship scheme of Government of India
    (Rashtriya Bal Swasthya Karyakram, RBSK) has been
    launched in February 2013 with a mandate to
    screen all children, aged 0-18 years for early
    detection and management of birth defects and
    other diseases.
  • Helping to subsidize services for poorer
  • Insurance is another way to provide high quality

Know More About How We Work
  • Child Heart Foundation
  • https//www.childheartfoundation.com/
  • 9999142268
  • sunita_at_childheartfoundation.com
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