الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion
Congenital heart disease (CHD) is among the more common major malformations at birth. Knowledge of the epidemiology of CHD is important in determining cause, allocating appropriate resources and planning effective prevention and management (Bolistty et al, 2004). About 0.8 % of live births are complicated by cardiovascular malformations (Webb et al., 2005).
Echocardiography is the standard investigation for the diagnosis or exclusion of CHD and for assessment of cardiovascular function (Wren, 2003). Echocardiography is used in neonatal units for the diagnosis and assessment of patent ductus arteriosus, for the assessment of myocardial function, pulmonary hypertension, and hemodynamic status, and for the recognition or exclusion of suspected CHD (Kluckow, 2008).
This study was designed to evaluate the incidence of congenital heart disease in the neonatal intensive care unit.
For this purpose, the present prospective study was conducted at the NICU, Pediatric department, Benha University. It included all newborns admitted to NICU over a period of six months from July to December 2011 with total number of 118 cases. The study group included 69 fullterm and 49 preterm neonates with a mean gestational age of 37.3+ 2.3 weeks. They were 74 males and 44 female with male/female ratio of 1.68. Echocardiography was done at mean postnatal age 13.8 + 11 days.
All newborn infants in this study were subjected to full history taking, through clinical examination as well as CXR and Echocardiography (M-mode, 2-D, Doppler and color flow maping).
The results of the present study showed that there was no statistically significant relationship between echocardiographic findings and sex or gestational age.
The presence of a positive family history carried a double risk of finding an abnormal echocardiography in comparison to cases with negative family history.
There was no statistically significant difference among the subgroups as regards postnatal age and gestational age
Central cyanosis detected CHD with a specificity of 100 %. So all patients presented with cyanosis with no respiratory distress were due to CHD.
The presence of a heart murmur was strongly predictive of CHD. There was a lack in the detection of the murmur at initial presentation compared to its detection at the time of echocardiographic examination. This means that while the presence of the murmur is strongly suggestive of CHD its absence does not exclude significant CHD, rendering a murmur a poor screening tool.
CXR has even lower sensitivities for detecting congenital heart disease.
Echocardiography identified 60 (50.8%) neonates with cardiac abnormalities. The commonest lesion was PDA, ASD, VSD, to be followed by TOF, TGA and other complex congenital heart
Patent Foramen Oval was detected in 25 patients (21.1%) which is normal findings for age.
Positive family history of congenital anomalies is considered the most important independent predictors for CHD after exclusion of other non significant predictors.
Mortality was higher among cases with abnormal echocardiography in comparison to normal group.
Our study highlight the role of echocardiography in the neonatal unit. Routine clinical, radiological assessment failed to detect all cases of CHD.
Conclusion
Echocardiography performed in the neonatal unit has a high yield for the diagnosis of structural and functional cardiac abnormalities.
CHD was detected in 48.3% (57\118) of neonates admitted to NICU.
Forty two% of a non requested cases (39\92) had CHD which would have been missed if a routine echocardiogram was not performed.
Positive family history (consanguinity) carries a higher risk of CHD.
Central cyanosis had a highly specific and positive predictive value for CHD.
CXR has lower sensitivity for detecting heart disease.
Mortality was higher among cases with abnormal echocardiography in comparison to normal group.