Heart failure can affect anyone of any age, including newborns. The causes and risk factors of heart failure depend very much on a patient’s age. Foetal heart failure (heart failure in utero) may occur due to anemia, arrhythmia, or even structural heart changes. Once born, structural heart disease is the most common cause of heart failure in the neonatal period.
Heart failure is a term used to describe the failure of the heart’s overall pump. Your heart is made up of four chambers that all work together to pump blood throughout the body. As this pump fails, your body may not be able to pump enough blood to oxygenate every part of your body. This can lead to heart enlargement, increased heart rate, and thicker heart wall muscular. All three of these conditions are the heart’s way of compensating for pump failure and trying to pump more blood throughout the body.
The neonatal period is typically defined as the first month of a child’s life. This time period is most often when heart failure appears in newborns. Once a child is born, there are many physiologic changes that occur within the first 24 hours of life. While in utero, a baby does not use their lungs and instead have fluid inside of their lungs. Once born, the baby’s first breath sets off a large pressure gradient through the lungs, heart and blood vessels. Increased oxygen in the lungs leads to decreased blood pressure in the lungs, and starts to shunt blood flow through the heart allowing the newborns heart to start pumping blood throughout the body. Holes that are originally in the foetal heart are closed as the pressure gradients equalize between systemic pressures and pulmonary pressures.
If a baby has a structural change in their heart and their anatomy is abnormal, then these birth transitions may not occur very smoothly. This can lead to heart failure in the early days of a newborn’s life or in the first 1 to 2 months of life depending on the heart lesion.
Neonatal heart failure can cause a variety of symptoms, both due to the heart’s pump failure and also due to compensatory mechanisms of the heart. Symptoms include:
The main treatment option for heart failure is to treat the underlying cause. If a patient’s heart failure is due to a structural lesion, then the lesion must be fixed to fix the heart failure. While waiting for surgery, medications such as diuretics and medications to increase the contractility of the heart (the pump strength) may be prescribed to help your child’s heart function.
Heart failure is a very rare issue that can occur in the neonatal period. Most babies with heart failure have a structural lesion that leads to failure of the pump action of the heart. Structural heart lesions are often known in utero so that parents and physicians can be ready when the baby is born to take care of the child’s heart.