Prevention Strategies For Infant Heart Issues

Heart issues in children are; more often than not, congenital, meaning that they are present from birth and are generally issues in the structure of the heart. Heart issues can also be acquired after birth often due to inflammatory reactions to viral or bacterial infection, whether congenital or acquired these heart issues can lead to challenges for the child and family, often though steps can be taken to prevent any heart issues in infants.

Although there is no guarantee of stopping congenital heart issues steps can be taken to reduce the risk as much as possible during pregnancy-

• Avoiding alcohol and drugs
• Ensuring vaccination against Rubella (German Measles) and flu
• Having Diabetes under control
• Avoiding certain medications (consult GP if unsure)
• Supplementing with 400 micrograms of folic acid daily, during the first trimester¹

Acquired cardiac issues can be caused by genetic factors, bacterial or viral infection or autoimmune disorder. These are less preventable and are usually managed by medical intervention, whether this be medication or; on the more extreme side, surgery. Genetic screening of family members and during pregnancy can give a picture as to whether the foetus would be born with a cardiac issue.

Approximately 1 in 100 (0.8%-1.2%) worldwide births are affected by congenital heart defects making them some of the most diagnosed congenital conditions.²

Understanding infant heart issues

Congenital heart defects

Congenital Heart Defects (CHD) are disorders that are present from birth and are often issues that arise from structural issues due to improper formation during foetal development. The most common of these are:

• Septal defects - this is where there is a hole in the wall between two chambers in the heart: between the two atria or two ventricles, This is often referred to as a hole in the heart³
• Coarctation of the aorta- this is the narrowing of the aorta (main large artery of the heart) so less blood can travel through.
• Pulmonary Valve Stenosis- this is the narrowing of the valve of the pulmonary artery, that takes blood to the lungs.

Other CHD can occur but are more rare, or can be a combination of many defects that are more serious yet rare.

Acquired heart diseases

Acquired Heart Diseases (AHD) occur directly after birth. They are less likely in children than adults and can occur due to viral or bacterial infections that cause inflammation or damage to the heart and vascular system. The most common are:

• Kawasaki Disease - This is inflammation of the blood vessels as the immune system begins to attack them, and may also be caused by some genetic factors.⁴ 
• Myocarditis - Inflammation of the muscle of the heart
• Pericarditis- Inflammation of the ‘sac’ (pericardium) that protects the heart
• Endocarditis- Inflammation of the lining of the heart valves or heart chambers⁵
• Cardiomyopathy - This is a thickening/stiffening of the heart's muscle fibres and leads to reduced function of the heart.⁶

Risk factors associated with infant heart issues

Infant heart issues can arise due to a combination of genetic, environmental, and maternal health factors. 

Genetic predispositions may play a key role with certain genetic mutations vastly increasing the likelihood of CHDs, the risk is increased if both parents have CHDs. 

The health of the mother is important during pregnancy as this can have a direct impact on the development of the foetus, this includes diet and lifestyle. Smoking and drinking alcohol can have a direct impact and can lead to CHD.

Environmental risks include toxins, air pollution or solvents. Medications can also be a risk factor, particularly blood pressure medication or acne medications, and medical conditions such as diabetes and rubella need to be under control as these increase the risk of CHD.⁷

Prevention

Prevention of heart issues begins before conception, quitting smoking and ensuring that any diabetes is under control, ensuring that the mother is either immune or vaccinated against rubella, this are the initial steps to reduce the risk of CHD. Prenatal care is important, with screenings being the best method for early detection so that any intervention can occur to prevent CHD.

Echocardiography (ultrasound imaging) can be used to monitor and assess the development of the foetus, theses are also often taken if there is a family history and therefore higher risk. Steps can then be taken to give the best possible chance of reducing CHDs, the measures taken can be lifestyle changes for the mother, ensuring she is a healthy weight; as obesity is a risk factor for CHDs, and folate supplementation for the mother can aid in preventing any CHD.⁸ Genetic counselling and testing play a crucial role in identifying families at higher risk, enabling early intervention and personalised care. Furthermore, raising awareness among parents about the warning signs and symptoms of infant heart issues is vital for prompt medical attention. Access to specialised medical care and support groups for affected families are also crucial components of prevention strategies, ensuring that infants receive the necessary interventions and support for optimal outcomes. By addressing these preventive measures comprehensively, the incidence and impact of infant heart issues can be significantly reduced.⁹ 

With infant heart issues it is hard to pinpoint an exact cause for each case, each genetic is different and more research is required to identify exact causes and then develop treatments and preventative measures.¹⁰

Summary

Infant heart issues whether acquired or congenital are best prevented through genetic screening and counselling; identifying high-risk pregnancies from those with a family history.

The mother's health during pregnancy is key to ensuring a healthy baby and reducing as much risk as possible for congenital heart diseases (CHD), this includes a healthy weight of the mother; obesity increases the risk greatly, avoiding smoking (Including passive smoking) and alcohol consumption.

Consulting a doctor regarding a Rubella (German Measles) vaccination, additional medicine that may affect a pregnancy (blood pressure or acne-related medicine) and ensuring that if the mother is diabetic it is under control and monitored correctly.

If all these external factors during pregnancy; diet, lifestyle and environment, are taken care of then these are the greatest steps that can be taken to prevent an infant's heart issues.