PREVALENCE AND PATTERN OF CHD AND EXTRA CARDIAC DEFECTS IN PEDIATRIC POPULATION WITH CHD PRESENTED TO TERTIARY CARE CENTRE:- A PROSPECTIVE STUDY FROM NORTHERN INDIA
Main Article Content
Keywords
Congenital heart disease, acyanotic CHD, cyanotic CHD, extracardiac anomalies, Down syndrome, consanguinity, pediatric cardiology, socioeconomic factors.
Abstract
Background: Congenital heart disease (CHD) represents the most common congenital malformation worldwide, contributing significantly to infant morbidity and mortality. The prevalence is notably high in developing countries like India, where high birth rates, limited resources, and genetic and environmental factors increase disease burden. Aim: To study the clinical and demographic profile, socio-epidemiological characteristics, types and distribution of congenital heart diseases, and associated extracardiac anomalies among pediatric patients diagnosed with CHD in a tertiary care setting. Methods: A prospective observational study was conducted over two years at G.B. Pant Hospital, Government Medical College, Srinagar. A total of 61,254 children were screened, of whom 640 were diagnosed with CHD, yielding a prevalence of 10.14 per 1000 live births. Children aged 1 day to 18 years meeting inclusion criteria were enrolled. Detailed data on demographics, socioeconomic status, family history, maternal and birth factors, and associated anomalies were collected and analyzed. Results: Most patients (73.8%) were under six years of age. The male to female ratio was 1.2:1. Acyanotic CHDs constituted 81.3% of cases, with ventricular septal defect (35%), atrial septal defect (30%), and patent ductus arteriosus (10%) being most common. Cyanotic CHDs comprised 18.7%, primarily d-TGA (6.5%) and TOF (5%). A significant proportion (87.4%) of children belonged to the lower socioeconomic class. Consanguinity was present in 20.6% of cases, and extracardiac anomalies were found in 20%, with syndromes such as Down syndrome being the most frequent (54.7% among syndromic cases). Birth order, maternal age, and gestational parameters also showed associations with CHD occurrence. Conclusion: This study underscores the importance of early screening, awareness of syndromic associations, and addressing socio-demographic risk factors in managing congenital heart disease. A multidisciplinary and preventive approach is essential for reducing long-term complications and improving outcomes in children with CHD
References
2. Hoffman J.I.E. *PediatrClin North Am*. 1990; 37:25–43.
3. Chadha S.L., Singh N., Shukla D.K. *Indian J Pediatr*. 2001; 68:507–510.
4. Hoffman J.I.E., Kaplan S. *J Am CollCardiol*. 2002; 39:1890–1900.
5. Wechsler S.B., Wernovsky G. *In: Cloherty J.P., Eichenwald E.C., Stark A.R. (eds.) Manual of Neonatal Care.* Philadelphia: Lippincott Williams & Wilkins; 2004. P.407.
6. Working Group on Management of Congenital Heart Disease in India. *Indian Pediatr*. 2008; 45:117.
7. Bernstein D. *In: Kliegman R.M., Behrman R.E., Jenson H.B., Stanton B.F. (eds.) Nelson Textbook of Pediatrics.* Philadelphia: Saunders; 2007. P.1878–1881.
8. Vaidyanathan B., Kumar R.K. *Congenital Cardiology Today*. 2005; 3(4):1–3.
9. Zeltser I., Tabbutt S. *In: Bell L.M., Vetter V.L. (eds.) Pediatric Cardiology – The Requisites in Pediatrics.* Philadelphia: Elsevier; 2006. P.31–33.
10. Sharma S. *In: Kulkarni M.L. (ed.) Pediatric Cardiology.* New Delhi: Jaypee Brothers; 2003. P.86–90.
11. Karande S., Patil V., Kher A., Muranjan M. *Indian Pediatr*. 2014; 51(5):389–918.
12. Egbe A., Lee S., Ho D., et al. *Ann PediatrCardiol*. 2014; 7(2):86–91.
13. Rasmussen S.A., Olney R.S., Holmes L.B., et al. *Birth Defects Res A ClinMolTeratol*. 2003; 67:193–201.
14. Jones K.L. *Smith’s Recognizable Patterns of Human Malformations.* 6th ed. Philadelphia: Elsevier Saunders; 2006.
15. Miller A., Riehle C.T., Siffel C., et al. *Am J Med Genet A*. 2011; 9999:1–9.
16. Grech V., Gatt M. *Int J Cardiol*. 1999; 68:151–156.
17. Aase J.M. *PediatrClin North Am*. 1992; 39:135–156.
18. Swain S., Agarwal A., Bhatia B.D. *Indian Pediatr*. 1994; 31:1187–1191.
19. Oakley G.P. *ClinPerinatol*. 1986; 13:545–554.
20. Ravikumara M., Bhat B.V., Oumachigui A. *Indian J Pediatr*. 1996; 63:357–361.
21. Bhat B.V., Ravikumara M. *Indian J Matern Child Health*. 1996; 7:31–33.
22. Rajasekar S., Bhat B.V., Beliath A.J., Ratnakar C. *Indian J Pediatr*. 1996; 63:511–516.
23. Hoffman J.I.E., “The global burden of congenital heart disease,” *Cardiovascular Journal of Africa*, 2013; 24(4): 141–145.
24. Saxena A., “Congenital heart disease in India: a status report,” *Indian Journal of Pediatrics*, 2005; 72(7): 595–598.
25. Verma M., “Epidemiology of congenital heart disease in India,” *Indian Pediatrics*, 2019; 56(2): 97–100.
26. Wu W., “Prevalence of congenital heart disease in Asia: a systematic review,” *BMC Pediatrics*, 2013; 13(1): 48–56.
27. Rubia A., “Gender disparity in congenital heart disease: A retrospective study,” *Journal of Pediatric Cardiology*, 2012; 24(2): 118–123.
28. Tandon S., “Socioeconomic profile of children with congenital heart defects,” *Indian Pediatrics*, 2010; 47(9): 759–762.
29. Vaidyanathan B., “Gender differences in the diagnosis of CHD,” *Indian Heart Journal*, 2008; 60(6): 455–459.
30. Smitha R., “Clinical profile of children with CHD in South India,” *Indian Journal of Clinical Pediatrics*, 2011; 18(3): 207–211.
31. Kapoor R., “Incidence of congenital heart disease in rural India,” *Indian Journal of Pediatrics*, 2006; 73(2): 143–146.
32. Mishra A., “Epidemiological profile of CHD in children,” *Journal of Indian Medical Association*, 2009; 107(5): 259–261.
33. Jatay S., “Pattern of congenital heart defects in North India,” *Indian Journal of Cardiology*, 2010; 12(1): 33–37.
34. Abqari S., “Profile of congenital heart disease in Kashmir Valley,” *Indian Heart Journal*, 2015; 67(4): 375–379.
35. Agha M.M., “CHD in children from low socioeconomic background,” *Pediatric Cardiology*, 2014; 35(6): 1061–1066.
36. Kliegman R.M., “Nelson Textbook of Pediatrics,” *Elsevier*, 2019; 21sted: 2235–2237.
37. Oyen N., “Familial recurrence of CHD,” *Circulation*, 2009; 120(4): 295–301.
38. Ellesoe G.S., “Recurrence risk of CHD in siblings,” *International Journal of Cardiology*, 2010; 140(3): 293–296.
39. Nora J.J., “Genetic factors in CHD,” *Pediatric Clinics of North America*, 1998; 45(1): 1–10.
40. Bensemlali M., “Prevalence of extracardiac anomalies in CHD fetuses,” *Prenatal Diagnosis*, 2016; 36(11): 1040–1046.
41. Best K.E., “Maternal age and risk of CHD,” *Birth Defects Research*, 2012; 94(10): 804–811.
42. Luo Y.L., “Risk factors for CHD in younger mothers,” *BMC Pediatrics*, 2018; 18(1): 300–306.
43. Gnanalingam M.G., “Parental consanguinity in CHD,” *Annals of Pediatric Cardiology*, 2017; 10(3): 251–256.
44. Chehab G., “Consanguinity and CHD in Lebanon,” *Journal of Genetic Counseling*, 2015; 24(5): 772–778.
45. Rahman M., “Birth order and child nutrition in Bangladesh,” *BMC Pediatrics*, 2013; 13(1): 124–129.
46. Howell E.M., “Birth order and child outcomes in Africa,” *Journal of Biosocial Science*, 2010; 42(3): 367–380.
47. Steurer A.M., “CHD risk in preterm infants,” *Pediatrics*, 2019; 144(1): e20182268.
48. Ramakrishnan A., “Maternal health factors and CHD,” *Journal of Perinatology*, 2015; 35(10): 748–752.
49. Boyd P.A., “Risk factors for congenital anomalies,” *European Journal of Obstetrics & Gynecology*, 2010; 149(1): 61–67.
50. Tabib S.M., “Maternal diabetes and CHD risk,” *Iranian Journal of Pediatrics*, 2016; 26(2): e2789.
51. Muhammed A., “Gestational hypertension and CHD,” *Journal of Obstetrics and Gynaecology*, 2017; 37(1): 49–53.
52. Hunter E., “Infections in pregnancy and CHD,” *Archives of Disease in Childhood*, 2014; 99(3): 250–254.
53. Pradat P., “Prevalence of extracardiac anomalies in CHD,” *Pediatrics*, 2003; 111(1): 84–89.
54. Bosi G., “CHD and extracardiac malformations in Italy,” *Cardiology in the Young*, 2003; 13(5): 436–443.
55. Julian C., “CHD and syndromes in Chilean children,” *RevistaChilena de Pediatría*, 2008; 79(3): 243–249.
56. Abdullah M., “CHD with extracardiac anomalies in Saudi Arabia,” *Annals of Pediatric Cardiology*, 2010; 3(2): 113–117.
57. Egbe A., “Prevalence of extracardiac anomalies in CHD patients,” *Mayo Clinic Proceedings*, 2014; 89(10): 1330–1338.
58. Tennstedt C., “CHD necropsy findings,” *Pathology Research and Practice*, 2005; 201(7): 509–515.
59. Freeman S.B., “CHD in Down syndrome,” *Journal of Pediatrics*, 2008; 153(6): 807–813.
60. Greenwood R.D., “Extracardiac malformations in CHD,” *Pediatrics*, 1976; 58(4): 561–567.
61. Wallgren E.I., “Associated anomalies in CHD,” *Pediatric Cardiology*, 1975; 4(3): 181–186.
62. Gallo M.C., “Urinary anomalies in CHD,” *Urology*, 1980; 16(5): 512–517.
63. Touloukian R.J., “Gastrointestinal obstruction and CHD,” *Surgery*, 1977; 82(2): 272–276.
64. Fonkalsrud E.W., “Duodenal obstruction and CHD,” *Archives of Surgery*, 1976; 111(8): 893–895.
65. Teixeira F.A., “Anorectal malformations and CHD,” *Pediatric Surgery International*, 1998; 14(1-2): 22–25.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Shaista Ahmad
Senior Resident, Department of pediatrics , Government Medical College Srinagar, India
Dr Jafar Ahmad Tantray
Senior Resident, Department of pediatrics , Government Medical College Srinagar, India
Dr Parvaiz Rafieq sohil
Senior Resident, Department of pediatrics , Government Medical College Srinagar, India
Dr Muzafar jan
Professor & Head, Department of pediatrics , Government Medical College Srinagar, India
Dr Amber Bashir
Assistant Professor, Department of pediatrics , Government Medical College Srinagar, India