Dr Jayaranganath M Sr Consultant Paediatric Cardiologist, Apollo Hospital, Bengaluru, shares his views on how parents can take care of their children amidst the ongoing COVID-19 crisis when help is limited
As the novel coronavirus continues to upend healthcare and economic structures around the world, its impact on patients with various health conditions is still unfolding. There is substantial literature stressing how patients with cardiovascular complications are at an increased risk. This is particularly alarming in case of new-born children with Congenital Heart Defect (CHD), a heart defect present at birth. With hospitals and healthcare professionals grappling to manage the COVID-19 crisis, what can parents with a child living with CHD do to protect him/her? There are many ways to manage the situation at home.
CHD comes with different symptoms and signs. In some cases, there will be none, but sometimes these can be life-threatening. Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD), and Patent ductus arteriosus (PDA) are the most common CHDs.
A hole in the upper chambers of the heart is called ASD which can increase the blood that flows through our lungs. Over time, this may damage the blood vessels in the lungs. Another defect, VSD is a hole in the wall between right ventricle and left ventricle. When this happens, the blood goes from the part of the heart to the other ventricle and this extra blood, when pumped into the lungs, forces the heart and lungs to work harder and eventually leads to an increased risk of many other health problems like stroke, heart failure, pulmonary hypertension (high blood pressure in the lungs) and irregular heart rhythms.
When connection between the heart’s two major arteries refuses to close after birth, it causes PDA, a medical condition in which the ductus arteriosus does not close after birth. The duct which is present in a developing foetus serves as a bridge between blood vessels.
There are more complex defects where babies are blue. In majority of these conditions, children need surgery and an immediate attention.
Seeking help at home
In the current times of coronavirus crisis when help is limited, it is challenging to manage these defects or even their symptoms. So, what can parents do at home? First things first, watch out for symptoms like difficulty in breathing, abnormal colour of fingertips or lips, abnormal heart rhythm. Check if the child is murmuring or not (sounds of the heart), if he/she is experiencing difficulty with feeding including fatigue during feeds, and also check for the weight. In many kids, there are no symptoms at birth and parents might see them after a few years. Now, how can you report these symptoms or seek help? Use virtual modes like telemedicine to connect with a specialist via audio or video calls. It is important to make sure that the doctor can see the child to manage his or her condition remotely.
According to statistics, “Considering a birth prevalence as 9/1000, the estimated number of children born with CHD every year in India approximates 240,000, posing a tremendous challenge for the families, society and healthcare system.” Technological advances, however, are helping us transform these numbers. We live in times when minimally invasive treatments are helping CHD patients live better lives with fewer complications.
A way with technological breakthroughs
For many decades, open-heart surgeries were the probable solution for many CHD conditions. With innovative solutions making a foray into healthcare, things changed, and course of treatments moved swiftly. Take for instance, cardiac catheterization where doctor inserts a catheter (a long, very thin tube) and moves it to your heart to repair the defect, has become a popular choice of treatment. This helps in repairing abnormal openings in the heart and closes them and treats a valve with stenosis. This is particularly vital for PDA, where a small closure device (occluder) can be inserted into the catheter. Once positioned correctly in the hole, the device is released and closes the opening. Now, the occluder not only helps in achieving complete closure, but such technologies are engineered to promote tissue in-growth and provide conformability. The complex ones, as described early, need to go to the referral hospitals and meet the pediatric cardiologist.
While the novel virus has upended the healthcare systems around the world, we must not lose hope. We have come a long way in managing CHDs and even if access to some of these technologies seems impossible, it is imperative that the symptoms are managed at home. It is important for parents to stay informed about the symptoms, the kind of technologies that are available and ensure their child is protected against infections of any kind. Needless to say, awareness is the key!