Cyanosis secondary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Secondary Prevention
Ultrasound follow-up
The necessity, timing, and frequency of serial assessment should be guided by the nature and severity of the lesion, presence of heart failure, anticipated timing and mechanism of progression, and the options available for prenatal and postpartum intervention [14]. At least one follow-up examination early in the third trimester is reasonable in order to look for abnormalities that progressed in severity or may not have been detectable earlier in gestation, and have peripartum clinical implications. Some causes of progressive fetal cardiac dysfunction include worsening valvular insufficiency or obstruction, increasing obstruction to blood flow in the great arteries, or development/worsening of myocarditis or cardiomyopathy, arrhythmias, or cardiac tumors [14].
This is also an appropriate time to screen for growth restriction, which may be more prevalent in these fetuses or specific subtypes of congenital heart disease [45-48].
All infants with severe PPHN who have been treated with inhaled nitric oxide (iNO) and/or extracorporeal membrane oxygenation (ECMO) should have neurodevelopmental follow-up [15]. Assessment should be performed through infancy at 6- to 12-month intervals, and longer if abnormalities are present. Hearing should be tested prior to hospital discharge and at 18 to 24 months corrected age.