Noises in the heart of a newborn: what does it mean

In a healthy person of any age, when operating the heart muscle, two tones should be heard:

• diastolic, accompanying the phase of relaxation and filling the ventricles with blood;
• systolic, corresponding to the moment of contraction of the cardiac muscle and the expulsion of blood into the systemic bloodstream.

Foreign sounds heard in the pause between tones are called noise, they do not correspond to the characteristics of the normal operation of the heart, drowning out its tones.

The period when a child is called a newborn (neonatal) is estimated to be four weeks from the moment of birth. Noises in the heart of a newborn child are often heard by neonatology pediatricians in the maternity ward. This news discourages young mothers and causes their anxiety and insomnia. There is certainly cause for concern, since the origin of the noise must be clarified, since it can indicate a serious pathology. This is just the case when vigilance will not be unnecessary. Finding out after careful examination that everything is in order is much more pleasant than missing the time and chance to restore the child's health.

[1], [2], [3], [4]

Epidemiology

The morbidity statistics show that different variants of small heart anomalies are found among 2.2-10% of the population.

Congenital anatomical anomalies of the heart make up a third of all malformations, and the tendency to increase the frequency of this pathology increases. With heart defects, approximately 0.7-1.2% of children are born, most of whom die by the end of the first year of life without surgical correction. The probability of the birth of children with structural anomalies of the heart and blood vessels in the family, where there is already a child with this pathology, is somewhat higher - about 5%.

[5], [6], [7], [8], [9]

Causes of the noises in the heart of a newborn

The most important criterion for the classification of noise is the cause of their occurrence. In out-of-school children, extraneous sounds accompanying the work of the heart may be manifestations of congenital anomalies of cardiac muscle development (pathological or organic causes), but can be caused by completely innocent, usually with time, disappearing causes associated with the reorganization and adaptation of the heart to life in new conditions outside the mother's womb.

Such noise refers to the category of innocents, they are also called functional or benign. They can occur in absolutely healthy babies and the causes of their appearance are the so-called small structural anomalies of the muscular and valve apparatus, which do not cause gross violations of blood flow:

• tendon filiform formations (ectopic trabeculae or falshhordy) in the left ventricle of the heart;
• open oval window;
• a long eustachian valve and others.

A number of violations related to small anomalies with age disappear, because they are fragments of embryonic circulation. Even if they remain, they often do not have a significant effect on the quality of cardiac activity. For example, prolapses of valves, more often - mitral, more rarely - tricuspid, also in most cases belong to small anomalies and is diagnosed often quite by accident. Severe degrees of such pathology (extremely rare) lead to blood flow disorders and require surgical intervention.

The causes of the appearance of functional noise may not be directly related to cardiac pathologies. The presence of perinatal infections, anemia, increases the burden on the heart, and the child listens for noises that disappear after eliminating such causes.

To benign or safe noise is the majority of systolic murmurs.

Extraneous sounds that are permanent and heard throughout the systolic phase, appearing in the diastolic phase of the cardiac muscle, and also - late systolic are considered dangerous. They are caused by defects in the development of the heart muscle, leading to gross violations of blood flow, which inevitably leads to oxygen starvation of other internal organs and tissues, a shortage of essential nutrients. There are developmental anomalies that are incompatible with life.

The most frequent causes of pathological or dangerous noise, audible during the work of the heart, are congenital (for the acquired defects the child is still too small) anatomical deviations from the norm:

• severe valve anomalies: mitral prolapse and stenosis, combined defect, prolapse of tricuspid valve;
• defects of the septa separating the atria or ventricles of the heart;
• severe degrees of malformations of the vessels, for example, segmental constriction (coarctation) of the aorta, open (after reaching the age of one year) Botallov duct;
• combined anomalies - lesions of two, three, four (tetralogy of Fallot) of structural elements of the heart;
• violation of the position (transposition) of the main vessels;
• abnormal drainage (partial or complete) of the pulmonary veins.

[10], [11],

Risk factors

The risk factors for congenital anatomical anomalies of the heart and major vessels are quite numerous. A negative role can be played by heredity, pathologically pregnant pregnancy, in particular, infectious and chronic diseases of the future mother, drug therapy during pregnancy, miscarriages and long-term infertility and the associated treatment, taking OTC drugs and vitamins during pregnancy. One can not fail to take into account the influence of an unfavorable ecological situation in the place of permanent residence of a pregnant woman, as well as her predilection for bad habits. The risk group also includes women who are older than 35 years of age. A serious factor that increases the likelihood of heart murmurs in the heart is delivery by Caesarean section.

[12], [13], [14], [15]

Pathogenesis

The pathogenesis of extraneous noise during the operation of the main muscular organ is associated with changes in intracardiac pressure and blood flow velocity in the main vessels, its turbulence, which is often provoked by a loose fit of valves, defects of partitions or vessels. Benign noises, as a rule, predominantly appear on the systolic phase of cardiac muscle activity with increasing blood flow through the semilunar valves (more often aortic), anatomically quite normal. Unlike the dangerous noise generated by structural anomalies of the heart valves, chambers or main vessels, the safe ones are caused only by the blood flow.

Noise in the heart is heard about every third newborn, however, it does not always indicate a disease. The likelihood that the noise in the heart of an infant is benign is almost equal to the fact that it is a symptom of congenital heart disease.

[16], [17]

Symptoms of the noises in the heart of a newborn

There are no rules without exception, however, diastolic murmurs are reflections of heart diseases. Noises that are heard constantly - too.

Systolic murmur in the heart of a newborn is treated not so uniquely. Most of the early systolic murmurs are functional, however, the pansystolic ones, audible throughout the systolic phase without a pause between heart tone and noise, are also considered dangerous. Such noises speak of the development of valvular insufficiency and the reverse flow of blood from the ventricle to the atrium or the non-spreading of the interventricular septum. Depending on the size of the hole between the left and right ventricles, this pathology is expressed by oxygen deficiency, and the child develops dyspnea.

Systolic murmurs may also indicate a narrowing of the aortic or pulmonary artery mouth.

Small anomalies in the development of the heart appear when listening to periodic systolic clicks.

Diastolic type of noise occurs mainly in the anomalies of the semilunar valves, which provide the direction of blood flow from the ventricles to the aorta and pulmonary artery, and also - with mitral constrictions. Noise in narrowing the diameter of the aortic or pulmonary artery is usually systolic.

The first signs of severe congenital anomalies are mainly found during prenatal examination or almost immediately after birth. Experienced obstetricians, having adopted a child, notice that everything is not right with him. The child is weak, with poor appetite, often regurgitates, the skin of the hands and feet are pale blue, there is a blue above the upper sponge, the nail bed and respiratory distress. During listening, pronounced noises, irregular heart rhythm and heart rate are detected. Blood pressure indicators also deviate from the norm.

More insignificant (small developmental anomalies) are often detected much later, but they also have less or no effect on the functioning of the cardiovascular system. Small noises in the heart of a newborn in the absence of other symptoms say, most likely, that the body is being rebuilt and adapting to the new conditions of autonomous existence. Such noise usually passes during the first year of life and does not represent any danger for the further development of the baby.

The arterial duct that connects the aorta to the pulmonary artery, open until a certain time, normally closes a week and a half or two weeks after birth, but even for a child aged two to three months, this is permissible. However, in children older than three months of age - this is pathology. The same is true for other moments of cardiovascular reorganization.

The oval window in the septum between the atria usually closes during the first month of life of the child. In some cases, it can close to the child's achievement of one-year-old age, but this will not affect hemodynamics. The child is healthy, develops normally, just from time to time it is supervised by a child's cardiologist.

Venous duct - communication with the umbilical cord of the central veins and venules of the fetus, is blocked by the child during the first-second hour of life, in some cases, more time passes or the venous duct remains.

Therefore, if after an acceptable period the anomalies of the heart structure do not disappear, they are considered to be vices and treated depending on the effect on the work of the cardiovascular system.

Noise in the heart of a newborn after a Caesarean section is a fairly common phenomenon. This operation is carried out only on strict indications, saving the life of the newborn and his mother. At the same time, the process of natural delivery and the triggering of the mechanisms of the child's autonomous existence outside the mother's womb is disrupted. Nature has foreseen that in the natural process of the birth of a child, a lot of work, while there is an adaptive restructuring. In an operative way, it is extracted in a compressed position of the body and carries out activities that artificially trigger the mechanisms of vital activity. A whole vital cycle falls out of the process - the pulmonary spreading, the first inhalation, the screaming, the circulation of liquids are disrupted. The risk of the appearance of children with developmental defects, including cardiovascular diseases, is thus much higher than in the case of natural delivery, since the very conduct of the Caesarean section indicates the presence of serious abnormalities and lack of confidence in the safe outcome of births naturally.

Complications and consequences

Benign heart murmurs caused by physiological causes pass independently and without treatment. Small anatomical congenital structural disorders of the heart muscle and major vessels are often unstable and self-disengaging with age.

Serious congenital heart defects affecting the pulmonary artery and pulmonary valve, the most complex of which are the tetralogy of Fallot and the wrong arrangement of the major vessels of the heart, require immediate surgical intervention to save the child's life.

The cases of birth of infants with holes in the septums between the atria or ventricles are quite frequent. The severity of this defect directly depends on the size of the hole, with this anomaly, there is a mixture of arterial and venous blood, as a result of which tissue hypoxia develops. Small holes often overgrow themselves, if necessary, close the hole - resort to surgical care.

Often a timely operation completely restores the health of the child, and he can live a full and long life. The non-operative course of congenital heart defects or untimely correction is fraught with the development of secondary immunodeficiency and a reduction in life expectancy. Most children (approximately 70%) with gross hemodynamic disorders due to cardiac abnormalities die in the first year of life. With timely cardiac care, mortality is 10%.

The lost time for the operation also leads to the development of irreversible disorders, in particular, various postoperative complications.

[18]

Diagnostics of the noises in the heart of a newborn

The very first diagnostic event is held in the maternity department. The neonatologist necessarily conducts a visual examination and listens to the tones of the child's heart. In the presence of extraneous sounds, as well as - additional symptoms (cyanosis, pallor, dyspnea) can recommend further examination.

The absence of noise in the heart of a newborn does not mean that there are no malformations of the heart muscle, however, gross anomalies that require immediate intervention are usually noticeable immediately.

The child will certainly be tested, in particular, a clinical blood test to exclude anemia and possible inflammatory processes. A biochemical blood test can also be informative in some cases.

Instrumental diagnosis, which allows to assess the condition of the newborn's heart, includes the following methods:

• electrocardiography - gives an idea of the basic parameters of the heart (rhythmicity, heart rate) and allows you to determine the extent of their deviations from the norm;
• phonocardiography, with which noises are recorded for their subsequent recognition;
• ultrasound examination of the heart (echocardiography) is a fairly informative method, which gives an almost complete picture of the structure of the organ and main vessels, pressure, velocity and direction of blood flow;
• tomography (magnetic resonance or computer), possibly with the use of contrast, allows supplementing data from previous examinations, identifying the smallest anomalies and features of the disease.
• Radiography and angiography, is prescribed if necessary
• catheterization - is carried out as a diagnostic measure, during which it is possible to immediately perform a minimal invasive intervention, for example, to correct a heart valve defect.

[19], [20], [21], [22]

Differential diagnosis

Differential diagnosis is carried out according to the data collected as a result of examination and examination of anamnesis. Small anomalies in the development of the heart and major vessels differentiate from so-called large or serious defects. The main criterion is the degree of danger of the symptom and the definition of further tactics of treatment. There is a high probability that noise will be recognized as harmless and the child will simply be on a dispensary record with a pediatric cardiologist.

[23]

Treatment of the noises in the heart of a newborn

In cases where, after examination, noises in the heart of a newborn are recognized as benign or caused by minimal structural changes in the heart muscle (trunk vessels), the child is not prescribed treatment. He is led by a local pediatrician, sometimes a cardiologist is required. Often, the noise passes by itself. If it turned out that the cause of functional noise is not heart disease, but the inflammatory process caused by a prenatal infection, anemia, rickets, rhesus conflict, then eliminate the detected cause, after which the child's condition normalizes and noises in the heart disappear.

If the noise in the heart of a newborn is recognized as pathological, that is, caused by congenital heart disease, mainly surgical treatment is indicated. However, they do not always resort to surgical treatment. If the child's condition is satisfactory, he is active, eats well and gaining weight, he does not have cyanosis and shortness of breath, he may be prescribed medication.

Drug administration is prescribed both in the preoperative period, and also after surgery. In some cases (if the defects are not subject to complete surgical correction) prolonged drug therapy is indicated. The treatment regimens are individual in each case.

In newborns with congenital heart defects it is necessary to compensate for heart failure and eliminate stagnation of venous blood. First of all, the baby is created with favorable surrounding conditions, he is placed in a bowl or a heated cot.

In mild cases with the initial stages of development of heart dysfunction, it is enough to reduce the load on the heart muscle, correcting the water-electrolyte balance. In addition, the feeding of a newborn with a probe is introduced, thereby reducing the effort that is applied to them during sucking. At the same time, oxygen therapy with regular monitoring of the gases in the blood is prescribed.

At any stage, drugs that activate metabolic processes and muscle nutrition of the myocardium are shown. These are enzymatic preparations, which are usually well tolerated. Interaction with cardiac glycosides, antianginal and inotropic drugs, which are also included in the treatment regimen, is positive. A baby can be assigned:

1. Cocarboxylase (a single daily dose is calculated individually for 10 mg / kg of body weight) - normalizing heart rhythm and preventing blood acidification, development of hypoxic encephalopathy, pneumonia, restoring blood circulation. Potentiates the action of cardiac glycosides and improves their tolerability.
2. Riboxin, which activates the redox processes in the heart muscle, its nutrition, normalizing the heart rate and blood circulation in the coronary vessels. It should be noted that the drug can occasionally increase the concentration of uric acid in the blood serum.
3. Panangin, normalizes the heart rhythm, the breakdown of which is caused by potassium deficiency (with hyperkalemia - not recommended), improves the absorption of oxygen and reduces the hypoxia of the heart muscle. The experience of using this drug in children is not enough, but sometimes it is prescribed.
4. Cytochrome C - improves cellular respiration, eliminates myocardial hypoxia and restores its trophic (dosed at 10 mg per injection).

Infants with heart defects are also prescribed diuretics to eliminate excess fluid and reduce the load on the heart muscle. Especially effective their appointment, when symptoms of interstitial pulmonary edema are observed.

For long courses of therapy, thiazides (Chlorothiazide, Cyclomethiazide), Veroshpiron are used, dosing 1-3 mg per day per kilogram of the child's weight. Triamterene can be prescribed if there is a threat of potassium deficiency - it is dosed at 0.3 mg per kilogram of weight. Usually oral. If urgent care is needed, a single intravenous injection of Furosemide is performed, the dose is determined at a rate of 1-3 mg per kilogram of the infant's weight, in severe cases it is increased to 8-10 mg / kg, the use of this drug is fraught with the opening of the Botallov duct, which is explained by the potentiation of the effect of prostaglandins. Each time the appointments are of an individual nature, perhaps a combination of diuretics with dosage adjustment.

Medications used to treat newborns with heart defects should restore and maintain normal heart rate and heart rate. For this purpose, cardiac glycosides are used, they are taken with long courses. Treatment begins with the fact that Digoxin is saturated with the newborn's body within a day or a half. The drug is administered more often intravenously, the dosage is calculated by the formula 0.03-0.04 mg Digoxin for each kilogram of the weight of the baby. For the first time, half the calculated dose is administered. Then twice, while maintaining an interval of eight to 12 hours, is introduced by another quarter of the dose. Next, they switch to maintenance therapy - an eighth part of the dose is administered every 12 hours. During the entire course of treatment with the drug, regular monitoring of the child's pulse rate is necessary, since the toxic effects of the drug occur very quickly in newborns. With a decrease in the pulse rate, the time interval between injections of the drug during the maintenance therapy is increased.

Appearance of signs of intoxication contributes: oxygen starvation of tissues, calcium deficiency, acidification of blood. With the introduction of Indomethacin (to suppress the autoimmune process), in order to avoid intoxication, the dosage of Digoxin is reduced by half. The toxic effect of this drug manifests itself as a refusal to eat, frequent regurgitation, vomiting, deterioration of the general condition.

To remove symptoms of intoxication appoint Unithiol, Lidocaine or Diphenin in antiarrhythmic doses.

If there is no response to therapy with cardiac glycosides, in the initial stage of heart failure, monotherapy may be prescribed with drugs depressing the enzymatic activity of exopeptidase (Capoten or Captopril). Dosiruyut drug individually, taking care not to reduce blood pressure in the baby, from the calculation of a daily dose: 1-4 mg per kilogram of its weight, which is divided into two or four injections.

In the second stage of cardiac ACE inhibitors are prescribed concomitantly with diuretics, while the third stage - treatment is performed against the background of Digoxin.

Stimulation of the contractile ability of the myocardium is carried out by cardiotonics of non-glycosidic origin (Dobutamine, Dopamine), dilating the vessels, increasing the contractility of the heart muscle and systolic blood volume. In a critical condition in the absence of cardiac contractions, Amrinon is used. Drugs of this group are used exclusively with careful monitoring of heart activity, correction of metabolic disorders, external respiration dysfunction and gas metabolism.

To prevent the development of endocarditis, newborns are prescribed antibacterial drugs.

Children with heart murmurs are recommended vitamin therapy: B vitamins - improve metabolic processes and trophic heart muscle, ascorbic acid promotes immunity, has antioxidant qualities. Not superfluous for the prevention of complications will be vitamins A and E. A doctor can prescribe a course of vitamins or a vitamin and mineral complex, depending on the results of a child's examination. Breastfeeding and nutrition of the mother are the best vitamins for a newborn with safe heart murmurs.

Physiotherapy treatment depends on the condition of the child and should be aimed at normalizing the functions of the heart: automaticity of the myocardium, its excitability and contractility, improvement of blood circulation in the large and small circle, delivery of oxygen to organs and tissues, especially to the brain, activation of immune processes.

For the prevention of hypoxia, babies can be appointed to the infant: sodium chloride (normalization of the sympathetic nervous system), oxygen (oxygen saturation), carbon dioxide (improves myocardial function, increases resistance to physical stress), iodine-bromine and nitrogen (have calming properties).

Immunostimulating procedures - sun and air baths, inhalations with ginseng, aloe extract and other immunomodulators.

In the presence of foci of chronic infection, local and general ultraviolet irradiation is used.

The procedures are contraindicated for heart failure of the second and third degree and in cases of complications with endocarditis.

Alternative treatment

Arsenal of prescriptions for alternative medicine for the treatment of heart diseases, including noise, is quite extensive. Basically - this treatment with herbs that have sedative properties and thinning the blood. However, the age of the patients we are interested in is too small to risk using decoctions and herbal infusions orally, but you can add infusions or herbal extracts to the tray. They disinfect the baby's skin and soothe it before going to bed, strengthen the immune system and give strength. Well-acting on the nervous system of needles, valerian, lavender, oregano and mint. In pharmacies, you can buy fees for the tray of herbs, for example, they mixed grass leaves of the motherwort and alternatives, the rhizome of valerian, leaves of lemon balm.

Restorative effects on the body have baths with sea salt for bathing children. The possibility and frequency of their use, as well as the concentration of salt, can be consulted with a doctor. Salt is bred separately in a bowl, and then filtered into the tub through four layers of gauze. You can add and infusion of any herbs (lavender, motherwort, mint).

It must be remembered that herbs can cause an allergic reaction in such a small child. To make a test, you need to moisten a piece of cotton wool in the broth or infusion of the herb and attach it to the skin on the handle, if in a quarter of an hour redness does not appear - you can bathe.

Decoctions and tinctures are prepared from the calculation - a handful of grass on a five-liter bath. Pour the grass with a liter of boiling water in an enamel, glass or faience ware, insist for about an hour, filter well and add to the prepared water. Collections of herbs are taken in proportions of 1: 1, making sure that there is no allergy to the components. Broths and infusions for bathing newborns use only freshly prepared.

[24], [25], [26], [27], [28], [29], [30]

Homeopathy

Therapy with homeopathic remedies is the safest for newborns. Even children with developmental defects are successfully succumbing to this treatment, exceptions are only those whose vices are not compatible with life, and their adaptation to extrauterine existence is, in principle, impossible. Such children need urgent surgical treatment, and in the rehabilitation period homeopathy helps to recover quickly and fully.

Doctors-homeopaths argue that the infant organism has excellent reactivity and, the younger the child, the faster it succumbs to homeopathic treatment. Prescribe drugs and dose them should a doctor homeopath. To stimulate cardiac activity, eliminate arrhythmia, hypoxia and normalize blood circulation in heart defects, more than forty drugs are used, among them - the same Digitalis, Camphor, Lily of the Valley, only in homeopathic dilutions.

Surgery

Correction of congenital anomalies in the structure of the heart and major vessels is carried out by open surgical intervention or, where possible, by minimally invasive technologies. Often as a result of the performed operations, the normal operation of the heart muscle is restored completely. In complicated cases, several operations are gradually performed in a number of stages, as a result of which the working capacity of the diseased organ significantly improves, the patient's condition stabilizes, the duration and quality of life increases.

Prevention

On the prevention of congenital developmental abnormalities in a future child, parents should think about before he was born. It is now established that a number of factors affecting a woman during pregnancy can increase the likelihood of the birth of a child with congenital heart diseases. Most of them can be warned. If it is not possible to influence the hereditary predisposition, the ecological situation in the region of residence and the age of the future mother, then it is completely within our power to eradicate bad habits - not to drink alcohol, not to smoke, not to engage in self-medication, to eat fully and lead a healthy life.

During the gestation period, the child should try to limit the possibility of infection. The flu, hepatitis, childhood infections (rubella, chickenpox, etc.), which are carried by the future mother, negatively affect the fetal development of the fetus.

Pregnant women with a dysfunctional family history, chronic diseases, adulthood are especially important to undergo all the prescribed diagnostic examinations during this period, do not take any medications and vitamins without first discussing it with the attending physician.

[31], [32], [33], [34], [35], [36]

Forecast

Functional or benign murmurs in the heart of the newborn have no negative effect on the functioning of the cardiovascular system, the quality and duration of further life will not. If no serious cardiac arrhythmias were found on the ultrasound of the heart, then there is no cause for concern.

Registration with a cardiologist and periodic preventive checkups are necessary to not miss the time to provide assistance (if needed).

If even a child is diagnosed with heart disease, a successfully performed operation can completely restore his normal functions, and the child will live a full life. Without surgery, most children with severe heart defects do not live to the age of one year.

[37], [38]