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Tiny Hearts, Big Risks: Why Heart Defects in Children Are Often Missed Until It's Late

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  Published in Humor and Quirks on Thursday, September 11th 2025 at 3:19 GMT by Onlymyhealth
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When the Silent Heartbeats Slip Past: Why Congenital Heart Defects Often Go Unnoticed Until Later On

Congenital heart defects (CHDs) are the most common birth defect worldwide, affecting roughly 1 in 100 babies. They range from minor structural abnormalities that close on their own to complex malformations requiring surgery in the first weeks of life. Yet a startling number of these conditions are not flagged until the child is older—sometimes years later—when the consequences of delayed treatment can be far more serious. A recent interview with Dr. Emily Park, a pediatric cardiologist at the Children’s Heart Institute, sheds light on why these silent conditions slip through the cracks, what can be done to catch them earlier, and why parents, clinicians, and policymakers all need to be more vigilant.

The Invisible Nature of Most CHDs

The first point Dr. Park emphasizes is that many CHDs do not present with obvious, dramatic symptoms at birth. A ventricular septal defect (VSD), for instance, may cause only a faint, tinkling murmur that can be mistaken for a normal heart sound in a newborn. An atrial septal defect (ASD) often produces no symptoms until adolescence or early adulthood. Because the heart’s workload is still relatively low in the first few weeks, the body can compensate, masking the underlying problem.

In addition, standard newborn examinations—checking for a palpable pulse, heart rate, and listening for murmurs—are inherently limited. A murmur may be faint, or the infant’s oxygen saturation might remain normal, even if a defect exists. Pulse oximetry, the most widely adopted screening tool, is a valuable addition but is not foolproof. “It has a sensitivity of about 90%, which is good, but it still misses a few critical cases,” Dr. Park notes. “You can have a large VSD that doesn’t lower the saturation, or a shunt that isn’t large enough to affect the readings.”

Why Many Babies Are Missed

1. A Low Index of Suspicion

Because CHDs are relatively common, the “normal” newborn is often the assumed baseline. Parents are reassured by routine assessments, and healthcare providers may focus on other early-life concerns (feeding, weight gain, developmental milestones) instead of a detailed cardiovascular workup.

2. Limited Screening Standards

Although the American Academy of Pediatrics (AAP) recommends universal pulse oximetry screening between 24 and 48 hours of life, this test is still optional in many hospitals and not uniformly applied. Even where it is performed, the cutoffs for a “positive” result can vary. Dr. Park stresses that “a single test can only tell you so much. Some defects simply do not affect oxygen saturation until the child ages.”

3. Asymptomatic Cases

Certain defects, like small septal defects or mild valvular insufficiencies, produce negligible symptoms. A baby may breathe normally, gain weight normally, and develop normally. “We can only suspect an abnormality if we hear a murmur or see something on a routine exam,” Dr. Park explains. “If the murmur is quiet and the child is thriving, the chance of missing it is higher.”

4. Overreliance on Pulse Oximetry

Pulse oximetry is excellent for detecting critical CHDs such as large VSDs or tetralogy of Fallot because these conditions drop oxygen saturation below 90% in the first days of life. However, it’s less sensitive for defects that do not produce cyanosis or for those that create murmurs but not a saturation drop. A study referenced in the article—published in Pediatrics in 2019—found that about 4% of critical CHDs were missed by pulse oximetry alone.

The Consequences of Delayed Diagnosis

When a heart defect is identified late, the patient faces a higher risk of complications:

• Pulmonary Hypertension: Over time, increased blood flow from a left-to-right shunt can elevate pulmonary artery pressure, eventually causing the shunt to reverse (Eisenmenger syndrome).
• Heart Failure: The heart may struggle to maintain adequate output, leading to fatigue, poor feeding, and failure to thrive.
• Arrhythmias: Certain structural abnormalities can predispose to dangerous heart rhythm disturbances.
• Systemic Complications: Uncorrected defects can increase the risk of endocarditis, stroke, and growth delays.

“The window for optimal intervention is often within the first few months of life,” Dr. Park says. “Beyond that, the risk of irreversible damage rises, and surgery becomes more complex.”

What Can Be Done

1. Strengthen Screening Protocols

The AAP and the Centers for Disease Control and Prevention (CDC) recommend universal pulse oximetry screening. However, hospitals must also be trained to detect subtle murmurs and be prepared to follow up on any abnormal finding. Some institutions are adopting a two-step approach: initial pulse oximetry followed by a focused physical exam and, if needed, a non‑invasive echocardiogram.

2. Educate Parents and Primary Care Providers

Knowledge empowers early detection. Parents who recognize signs such as poor feeding, excessive fatigue, or rapid breathing should seek evaluation promptly. Pediatricians can incorporate a quick heart assessment during routine visits, particularly for infants showing these red flags.

3. Incorporate Echocardiography into Protocols

The article cites a study that integrated routine bedside echocardiography into newborn screening in a tertiary center. The result: a 25% increase in early CHD detection and a reduction in hospital readmissions for heart failure.

4. Genetic Counseling and Family History

Certain CHDs cluster in families or appear with chromosomal abnormalities (e.g., Down syndrome). A detailed family history can raise suspicion and prompt earlier imaging.

5. Policy and Funding

Advocacy for standardized screening, insurance coverage for echocardiograms when indicated, and public health campaigns can all play a role. Dr. Park highlights the importance of governmental support: “Funding for early screening is an investment in long-term health savings by preventing the costly complications of delayed repair.”

The Take‑Away Message

Congenital heart defects, though often hidden, are not inevitable culprits of late morbidity if they’re found early. The article underscores that a combination of improved screening protocols, heightened clinician awareness, and proactive parental involvement can catch most defects within the critical first weeks of life. When these steps are combined, the risk of long‑term complications plummets, turning a potentially life‑altering diagnosis into a manageable condition.

For parents, the key takeaway is vigilance: monitor feeding patterns, growth, and breathing. For clinicians, the message is clear: don't rely solely on a pulse oximeter reading; conduct a thorough heart exam and consider early echocardiography when in doubt. And for policymakers, the imperative is to support universal, evidence‑based newborn cardiac screening—because every silent heartbeat can be heard if we listen closely enough.