Introduction

Heart problems in newborns, also known as congenital heart defects, are structural abnormalities in the heart that are present at birth. These defects can range from minor issues that have minimal impacts on a child’s health to severe conditions requiring immediate medical intervention. Recognising congenital defects early is paramount for an infant’s well-being. 

The early detection and diagnosis of heart problems in newborns are crucial for several reasons:¹ 

1. Early diagnosis allows healthcare professionals to begin delivering treatment and management strategies promptly, which can significantly improve outcomes for affected infants
2. Early intervention can help prevent complications and reduce the risk of long-term health issues associated with congenital heart defects

For parents and caregivers, understanding the signs and symptoms of heart problems in newborns is essential for advocating for their child's health and seeking timely medical attention when needed. By being aware of the signs and symptoms of heart problems, parents can play a proactive role in their baby's care.

In this article, we will explore the common signs of heart problems in newborns, providing valuable insights into what to watch out for, and what steps to take if any concerns arise. Through this information and guidance, we aim to empower parents and caregivers to navigate the complexities of newborn heart health with confidence and assurance.

Common signs of heart problems in newborns

Cyanosis

Cyanosis refers to a bluish discolouration of the skin and mucous membranes, typically caused by insufficient oxygen in the blood. In newborns with heart problems, cyanosis may occur due to poor circulation or the inappropriate mixing of oxygen-rich and oxygen-poor blood.² If your child has cyanosis, you may notice they have bluish lips, tongue, or extremities (fingers and toes), particularly while feeding or crying.

Rapid breathing

It's normal for newborns to have rapid breathing, but abnormally fast breathing rates may indicate an underlying heart issue. While the average breathing rate for a newborn is around 30-60 breaths per minute, persistent rapid breathing, especially at rest, can be a red flag. This sign is significant as it suggests the heart is having to work harder than usual to meet the body's oxygen demands.

Poor feeding and growth

Difficulty feeding or poor weight gain can be indicative of heart problems in newborns. Babies with congenital heart defects may tire easily during feeding due to the increased effort required to breathe and suckle.³ As a result, they may consume less milk and struggle to thrive, leading to poor weight gain and growth.

Persistent fatigue or weakness

Unusual lethargy (tiredness) and decreased activity levels in newborns could signal an underlying heart issue. While newborns typically sleep a lot, excessive fatigue or weakness warrants attention. These symptoms may indicate that the heart is unable to pump blood effectively to meet the body's needs, leading to decreased energy levels.

Less common signs

Heart murmurs

Heart murmurs are abnormal sounds heard during a heartbeat, often indicating turbulent blood flow within the heart. While some murmurs are harmless, others may suggest an underlying structural abnormality in the heart. Evaluation by a healthcare professional, such as a paediatrician or paediatric cardiologist, is essential to determine the significance of the murmur and whether further investigation is required.

Changes in skin colour

Pallor, or paleness of the skin, can occur in newborns with heart problems due to reduced blood flow to the skin.⁴ Sweating, especially during feeding or exertion, may also be a sign of an underlying heart issue. These changes in skin colour may accompany other symptoms, such as rapid breathing or poor feeding, suggesting the need for medical evaluation.

Abnormal heart rate or rhythm

Newborns with heart problems may show abnormal heart rates or rhythms, such as bradycardia (slow heart rate) or tachycardia (fast heart rate). An irregular heartbeat - which is characterised by erratic or uneven heartbeats - may also be present. These abnormalities may be detected during routine check-ups or by monitoring the baby's pulse, but should be investigated further by a doctor.

Diagnosis and evaluation

Physical examination

During a physical examination, clinicians carefully observe newborns for any signs or symptoms that may indicate a heart problem. This includes assessing the baby's skin colouration, breathing patterns, and overall appearance. Signs such as cyanosis (bluish discolouration of the skin), rapid breathing, or poor feeding can provide important clues about the baby's heart health.

Listening to heart sounds

Listening to the heart sounds, also known as auscultation, is a crucial part of the physical examination. Healthcare professionals use a stethoscope to listen for any abnormal sounds, such as murmurs or irregular rhythms, which may suggest an underlying heart condition. By carefully listening to the heart, doctors can gather valuable information about the structure and function of the baby's heart.

Diagnostic tests

Echocardiogram

An echocardiogram is a non-invasive test that uses sound waves to create a detailed image of the baby's heart. This test allows clinicians to evaluate the structure and function of the heart, including its chambers, valves, and blood flow patterns. Echocardiograms are particularly useful for diagnosing congenital heart defects and assessing the severity of any identified condition.

Electrocardiogram

An electrocardiogram, or ECG, is used to measure the electrical activity of the heart. This test involves placing electrodes on the baby's chest to record the heart's electrical impulses. By examining the ECG tracings, clinicians can identify abnormalities in the heart's rhythm and detect signs of arrhythmias (irregular heartbeats) or other electrical disturbances.

Chest X-ray

A chest X-ray may be performed to provide additional information about the baby's heart and lungs. This imaging test allows clinicians to assess the size and shape of the heart, as well as identify any abnormalities in the surrounding structures. Chest X-rays can help confirm a diagnosis of heart problems and guide further evaluation and treatment.

Referral to paediatric cardiologist

If a heart problem is suspected or diagnosed, newborns can be referred to a paediatric cardiologist for further evaluation and management. Paediatric cardiologists are specially trained to diagnose and treat heart conditions in infants and children. They may perform additional tests to gather more information about the baby's heart and determine the most appropriate treatment plan.

Long-term management of newborns with heart problems

After the initial diagnosis and treatment of heart problems in newborns, long-term management becomes essential to monitor the baby's heart health and address any ongoing issues. This may involve:

Medication adherence

Many newborns with heart problems require ongoing medication to help manage symptoms and prevent complications. It's important for parents and caregivers to ensure their child takes their medication as prescribed by their doctor. This may involve establishing a routine and using tools such as pill organisers or reminder apps.

Regular follow-up appointments

Regular follow-up appointments with a paediatric cardiologist are crucial for monitoring the baby's heart health and assessing their progress over time. These appointments may include physical examinations, diagnostic tests, and discussions about the baby's growth and development. By attending these appointments, parents can stay informed about their child's condition and any changes that may occur.

Lifestyle modifications

In some cases, lifestyle modifications may be recommended to help support the baby's heart health. This may include dietary changes, such as reducing salt intake or increasing fluid intake, as well as promoting physical activity and maintaining a healthy weight. By adopting a heart-healthy lifestyle from an early age, parents can help reduce the risk of complications and improve their child’s overall well-being.

Prognosis for newborns with heart problems

The prognosis for newborns with heart problems varies depending on the specific condition, its severity, and the effectiveness of treatment.⁵ While some babies may experience significant improvements in their heart function and quality of life, others may face ongoing challenges or complications. However, with advances in medical technology and ongoing research, the prognosis for many newborns with heart problems has improved significantly in recent years.⁶

It's important to remember that every child is unique, and the prognosis for each baby will depend on a variety of factors. By working closely with healthcare professionals and following their recommendations for long-term management, parents can help optimise their child's prognosis and ensure the best possible outcomes for their heart health.

FAQs

How do I know if my newborn has a heart problem?

Look out for signs like bluish skin, rapid breathing, poor feeding, and persistent fatigue.

Consult a paediatrician if you notice any concerning symptoms or if your baby doesn't seem to be thriving as expected.

What are the early symptoms/warning signs of congenital heart disease?

• Difficulty feeding
• Rapid breathing
• Poor weight gain
• Bluish skin

What causes a baby to be born with heart problems?

Congenital heart defects can have various causes, including genetic factors, maternal health issues during pregnancy, exposure to certain medications or substances, and environmental factors. In many cases, the exact cause remains unknown.

What does heart failure look like in a baby?

Signs of heart failure in babies may include difficulty breathing, rapid breathing, excessive sweating, poor feeding, and swelling (oedema) in the legs, abdomen, or other parts of the body. Prompt medical evaluation is essential if you suspect your baby may be experiencing heart failure.

How do I make sure my baby has a healthy heart?

• Attend all antenatal clinic appointments, and adhere to your clinician's advice for a healthy pregnancy
• Ensure proper nutrition and avoid harmful substances during pregnancy
• After birth, monitor your baby for any signs of heart problems and seek medical attention if needed
• Follow a healthy lifestyle, including regular check-ups and vaccinations, to promote overall heart health

What is the most common heart problem in infants?

Ventricular septal defect (VSD) is among the most common congenital heart defects in newborns. It involves a hole in the wall (septum) between the heart's lower chambers (ventricles), leading to abnormal blood flow and potential complications.

Summary

Heart problems in newborns, also known as congenital heart defects, can present challenges for parents and healthcare professionals alike. Key signs of heart problems in newborns include cyanosis (bluish skin), rapid breathing, poor feeding, and persistent fatigue. Diagnosing these issues often involves physical examinations and specialised tests such as echocardiograms and electrocardiograms.

Treatment options may include medications, surgery, or catheter procedures, tailored to the individual needs of the baby. Long-term management involves medication adherence, regular follow-up appointments, and lifestyle modifications to support the baby's heart health and overall well-being. With proper care and support, newborns with heart problems can lead fulfilling lives and thrive as they grow.