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0CLINICAL-ANAMNESTIC CHARACTERISTICS OF CHILDREN BORN WITH CONGENITAL HEART DEFECTS AND ASSESSMENT OF THEIR PHYSICAL DEVELOPMENT
Isakhanova N.Kh.
Tashkent Pediatric Medical Institute https://doi.org/10.5281/zenodo.13350684
Abstract. At present time the problem of congenital heart defects (CHD) remains relevant throughout the world. According to the World Health Organization information, annually 303,000 children die from developmental defects in the first 4 weeks of life. Children born with congenital heart defects have unique physical and motor developmental characteristics that have a significant impact on child's life and require special attention when carrying out rehabilitation methods.
Keywords: congenital heart disease (CHD), classification, anamnesis, physical development; rehabilitation.
Introduction: Over the past two decades, significant advances in the medical and surgical treatment of patients with congenital heart disease (CHD) have significantly increased their life expectancy, and the majority of children with CHD are expected to reach adulthood without any major physical impairment at present time. Consequently, patients, pediatric cardiology providers, and researchers have shown increasing interest in patient-related outcomes such as health-related quality of life [1,2].
It is important to suggest that the first year of child's life is considered a period of rapid development, and in children with CHD it has an adverse effect on child's physical and psychomotor development, as well as on the functioning of the cardiovascular system. Assessing the stage of growth and development of children born with CHD is considered one of the main tasks of pediatricians [3,4].
Definitely, modern medical literature has identified the main causes of health problems in children who have undergone CHD surgery: residual stages of hemodynamic disorders, the volume of surgical intervention, time spent on artificial circulation, as well as the most proven social reasons [5,6].
Besides that, the prevalence of congenital heart disease is approximately 6/1000 live births, making it the most common severe congenital anomaly and a significant contributor to mortality in the first year of life [7,8]. Congenital heart defects typically cause developmental changes, primarily in height and weight, which when measured are below average for age [9,10]. These changes are usually multifactorial and can have both cardiac and noncardiac causes [11-12].
Foreign specialists have achieved good results by using a number of measures for the physical rehabilitation of children with CHD at the pre- and postoperative stages [13,14].
The European guidelines (2017) on physical activity for children with CHD emphasize that optimal physical activity has a positive effect on the development of anthropometric characteristics, physical qualities and cognitive abilities [15,16]. It has been proven that effective physical cardiac rehabilitation programs can achieve optimal physical performance and quality of life in children with coronary artery disease after surgical treatment [18,17].
At present time the development of care for children born with ENT pathologies in pediatrics is at its peak. Thus, in the early postoperative period, the main indicators of the development of complications are considered to be the study of family history, immunogenetic markers, the degree of retardation of physical development, and the influence of social adaptation in the psychoemotional and neurolinguistic directions.
The purpose of the research: to study the clinical and anamnestic features of children born with CHD, as well as the growth and development of a child in the first year of life.
Research methods: The study was conducted prospectively in the clinic of Tashkent Pediatric Medical Institute with 64 children, who were monitored in the first year of life during 2022-2023. The main group included 34 children diagnosed with CHD. The control group included 30 children of health groups I-IIA without CHD.
Study criteria: the age of the child in the main group is 0-12 months, there is a diagnosis of congenital heart defects, and parental consent for the study has been obtained. The study did not include: children older than 1 year, children with extracardiac pathology in the stage of decompensation, children of parents who did not consent to the study.
Assessment of the health complex includes anamnesis data, assessment of physical and psychomotor development, objective examination, analysis of children's morbidity and determination of the health group.
Results obtained: According to the results of the study, children of the main group were divided into 2 subgroups based on surgical intervention: 18 (58.1%) children of the IA subgroup who underwent surgery in the first year of life for CHD, and the IIA subgroup included 13 (41.9 %) of children who did not require surgical intervention in the first year of life with CHD.
Based on the results of the analysis, the main group was divided into 3 subgroups based on hemodynamic disorders. In subgroup IB there were 11 children (32.8%) with severe hemodynamic disorders with cyanosis, in subgroup IIB - 12 children (34.4%) of aeonatic CHD, in subgroup IIIB - 11 children (32.8%) with moderate and mild hemodynamic disturbances.
In the study, the main group consisted of 44.3% (n=15) boys and 55.7% (n=19) girls. In subgroup IA, 44.1% (n=8) were boys, 55.9% (n=10) were girls, and in subgroup IIA, 44.4% (n=6) were boys and 55.6% (n= 7) - girls, and in subgroup IB there were 45.0% of boys (n=5), 55.0% of girls (n=6), in subgroup IIB 47.6% (n=5) were boys and 52.4% (n =7) were girls, in subgroup IIIB 40.0% (n=4) were boys and 60.0% (n=7) were girls. In control group, boys made up 49.1%, girls - 50.9%. Reliability did not differ between gender equality survey groups. The average age of the operated patients was 55.4 ± days.
Diagnosis of congenital heart defects was divided in the table below according to the generally accepted classification based on clinical and instrumental examination of the disease:
№ Types of CHD N=34 %
1 Cortation of the aorta 4 10,1
2 Hypoplastic left heart syndrome 3 8,5
3 Transposition of the great vessels 1 4,8
4 Ventricular septal defect 10 29,4
5 Inter chamber barrier defect 9 25
6 Fallot in Tetra 2 7,3
7 Patent ductus arteriosus, common atrioventricular canal (complete and incomplete types) 4 10,2
8 Pulmonary stenosis 1 4,7
According to the table, 10.1% (n=4) - with coortia of the aorta, 8.5% (n=3) - with hypoplasia of the left heart, 4.8% (n=1) - with aortic hyperplasia, 29.4% (n=10) - with ventricular septal defect, 25.0% (n=9) - with interchamber barrier defect, 7.3% (n=2) - with Tetralogy of Fallot, 10.2% (n=4) - with patent arterial canal, common atrioventricular canal, 4.7 %(n=1) - with pulmonary artery stenosis.
In the control group, 54.7% (n=16) belonged to health group I and 45.3% (n=14) to health group IIA, that is, children with functional disorders. Among the functional disorders in children of health group IIA, the following were identified: allergic diseases in 17.0% (n=2), 15.1% (n=3) - with upper respiratory tract infections, 11.3% (n=1) - with hyperbilirubinemia , 1.9% (n=1) -with urinary tract infections.
It is important to suggest that anamnesis data showed that the average age of the mother, the average number of pregnancies and births, as well as the mother's obstetric history and the course of pregnancy did not reveal differences in the reliability index in children with SUN compared with children in the control group.
In mothers of children born with CHD, the probability of conception was higher at an average age of 30.7 ± 3.8 (min 25, max 39, Me 30.5) and an average number of fetuses 2.7 ± 1.8 (min 1, max 6, Me 2), the number of births was set to 1.9±1.0 (min 1, max 5, Me 2). This indicator did not differ in reliability relative to the control group.
Obstetric history of the children observed
Symbols Main group Control Group P
M±o; (Me), M±o; (Me), (t)
n=34 n=30
Number of pregnancies 2,7±1,8; (2) 2,4±1,1; (2) -
Number of births 1,9±1,0; (2) 1,8±0,8; (2) -
Mother's age at the time of 30,7±3,8; (30,5) 31,5±5,4; (30) -
birth
The mothers of two groups of children had a complicated obstetric history (artificial termination of pregnancy, early miscarriage), complications during pregnancy (gestosis, extragenital pathologies, urogenital infections), infectious conditions during pregnancy (infectious diseases of the respiratory tract and urinary tract) were found at the same rate.
Children with CHD were more often born prematurely compared to the control group (27.7% vs. 0%; p<0.001), had a lower APGAR score (in the first minute - 6.4±1.2 vs. 7.1±0, 5). ; r<0.001; and at the 5th minute - 7.4±0.5; r<0.001), it was found that the majority were born in a serious condition (27.9% and 0.001), the general condition deteriorated in the first day of life (8.2). % and 0%; r<0.04), and growth and development indicators at birth were very low (p<0.02).
Morbidity rates showed that the prevalence of perinatal nervous system disorders was higher in more than half of the children in the main group compared to the control group. (65.6% and 18.9%; r<0.001).
During the observation period, respiratory diseases were observed in 58.9% of children with CHD compared with the control group (34.0%, p <0.03).
While analyzing the child's diet, 19.7% (n=7) of children in the main group were breastfed in the first year of life, 55.7% (n=19) were bottle-fed, 24.6% (n=8) were mixed-fed control. In the group, 37.7% (n=11) were breastfed, 5.7% (n=1) were bottle-fed and 56.6% (n=17) were mixed-fed.
The level of breast milk and mixed feeding was significantly higher than in the control group (p<0.04, p<0.001), and in the main group, formula-fed children predominated. (p<0.001).
It was found that 14.8% (n=2) were transferred to artificial feeding at 3 months of life, 6.6% (n=4) up to 6 months and 3.3% (n=2) up to 12 months.
A third of children with CHD, 78.7% (n=50) were born with a body weight of more than 2500 g, 21.3% (n=14) were born with a body weight of less than 2500-1500 g. Lower body weight was only in the main group. (21.3% and 0% respectively 40%, r<0.001). In general, it was found that children with CHD had lower birth weight compared to the control group - 3148.4±668.6 g and 3399.1±346.0 g (p<0.02).
Anthropometric parameters at birth
Symbols Main Group Control group P(t)
Birth weight (g) 3148,4±668,6 3399,1±346,0 p<0,02
Body length at birth (cm) 50,4±3,8 52,0±1,9 p<0,01
In children with CHD in the first year of life, body length turned out to be average (2575%). But in children of the control group, a significant indicator of the length of the lower body was observed after 3 months (p<0.002) and 12 months (p<0.02). There was no difference in growth over the year between the main and control groups - 23.7±3.2 cm and 24.8±2.3 cm, respectively. Indicators of weight and body length of children under supervision
Body length Age , months Main group Control group P (t)
M±o, cm Length index/ag e %o M± o, cm Length index/age 0%o
3 59,0±3 ,9 25-75 61,1±2,2 25-75 p<0,002
6 66,3±3 ,2 25-75 67,0±3,1 25-75
12 75,1±3 ,1 25-75 76,7±2,0 25-75 p<0,02
Body length Age, month Main group Control Group
M±o, r Length index/ag e %o M± o, g Length index/age o%0
3 5112,3 ±1133, 7 <25 5996,3±726,2 25-75 p<0,000 5
6 6850,6 ±1128, 8 <25 7825,0±997,6 25-75 p<0,000 5
12 9169,0 < 25 10001,0±1107,3 25-75 p<0,03
±1356,
6
Children with CHD were more likely to be delayed in physical development in the first year of life compared to their healthy peers. In the first year of life, compared with the control group, there was an average decrease in body weight (<25%). (p=0.000 -3rd and 6th months, p<0.03 -12th month).
Symptoms of protein-energy malnutrition accounted for 44.4% in the main group of children with CHD and 11.6% in the control group (p <0.001). Over the years, it has been established that the development of protein-energy malnutrition in children with CHD increases (from 39% from 3 months to 55% from 12 months).
In children with CHD at 1 year of life, the delay in neuropsychic development was more significant than in the control group, and was manifested by a slowdown in general emotions and active speech. In the first year of child's life, CHD as an etiological factor, the decrease in neuropsychic development was 29.5%, and in the 3rd month of life the maximum figure was 68.7%.
CHD was detected in more than half (58.4%) of the children in the main group; the rate of symptom reduction over 3 months of life was 66.7%, and over 1 year - 45.0% (p < 0. 03). In addition, a sharp decrease in the level of SUE 2A was revealed from 25.9% to 5% (p <0.008).
By summarizing it should be concluded that a comprehensive assessment of children's health showed that children born with CHD have a severe course of the early neonatal period (low Apgar score, severe condition at birth, severe condition on the first day of life), delayed physical development, high risk body weight. It has been established that protein energy deficits also lead to the formation of health groups III (64.1%) and IV (35.9%) at a high level in the first year of child's life.
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