In developed countries the expanding scope of pediatric cardiology has achieved a dramatic improvement in outlook for infants with congenital heart disease.

Critical advances include:

  • Continuing improvement of diagnostic capabilities with the use of ultrasound technologies in the fetus and newborn infant permitting early diagnosis and case-specific management
  • High standards of infant care in regional hospitals with designated standards of resuscitative equipment
  • Neonatal transport systems to take sick babies to defined institutions where cardiac therapies can rapidly be instituted
  • A notable change in philosophy from the early fear that an infant was “too small” or “too sick” to move to prompt action in transfer to initiate diagnostic improvements with gratifying results (Rowe, 1981)
  • Surgery is performed in a high proportion of infants with severe cardiac anomalies:
    • “palliative” surgery offers relief of major circulatory disturbances
    • “definitive” surgery attempts to restore the cardiac anatomy to normal

In the Baltimore-Washington Infant Study infants born in the decade 1981-1989 were followed until their first birthday. In that time period one third of the cases (34%) underwent cardiac surgery. The need for re-operation during childhood remains a possibility for many.

In the developing world
a great public health challenge still exists. Most infants with congenital heart disease do not survive the first weeks and months of life. Death comes as a result of hypoxia (blue babies), congestive heart failure aggravated by anemia and infections such as pneumonia superimposed in pulmonary congestion. In the absence of adequate diagnostic and treatment facilities these little patients succumb to complications for which treatments are available elsewhere sometimes even in nearby medical centers. The Association of Children with Heart Disease in the World began to confront this need establishing collaborative treatment facilities locally and by visiting consultants. (Giamberti, 2004)

Selected References