Treatment of congenital heart defects depends on which part of the heart is affected. In some cases, depending on the severity of the heart defect, drug treatment is the best option.
Some infants will not need treatment if the effect on blood flow is minor, while others will require medication or intervention such as cardiac catheterization or surgery. Many heart defects can be successfully managed, often in early infancy and sometimes even in the womb, before the baby is born. Some defects aren’t treated right away, but are treated when the child is older. And some defects are treated in stages. While heart defects generally aren't “curable,” they can be managed well enough to enable the child to function well.
Treatment of congenital heart malformations must also take into consideration other factors and complications that are frequently present in premature babies. A baby’s size and weight may be considered too small for surgery and so surgical procedures to repair heart malformations may have to wait until the baby has grown and is in a better position to endure the surgery.
If other complications are present, such as lung problems, these issues may also change the course, timing, and perhaps outcome of treatment.
Drug therapy
Depending on the type of heart defect an infant has, it may be beneficial to have the ductus arteriosus remain open. In the womb, the fetus gets oxygen from the mother. As there is no need for blood to pass through the lungs of the fetus, the blood is diverted away from the lungs by an artery called the ductus arteriosus.
Under normal conditions, once a baby is born, the ductus arteriosus begins to close, never to open again. However, with certain types of congenital heart defects, having some of the blood continue to be diverted away from the lungs is a benefit for a period of time. To keep a ductus arteriosus open, a baby will be given prostaglandin E2 (PgE2) which encourages the ductus arteriosus to remain patent or open. In some cases, this treatment will continue for weeks or months until such time as the baby is deemed ready enough for surgery. Special care will be given to the amount of PgE2 administered to the baby since there are several complications that can arise from its use such as apnea or periodic interruptions in breathing, gastric outlet obstruction which is a condition that makes emptying the bowels difficult, and hyperostosis or abnormal bone growth.
Monitoring
All babies in the NICU are monitored. Those with congenital heart malformations will be monitored specifically to confirm that blood flow and circulation in general, though probably abnormal at least to some extent, remains strong enough to sustain the baby until such time as surgery or some other treatment can begin. In other words, the abnormal blood flow should still be able to deliver sufficient oxygen to all parts of the body so that the baby can gain strength and does not worsen while waiting for the next step in treatment.
Levels of plasma lactate and signs of metabolic acidosis will be checked to monitor the adequacy of the blood flow. If the baby is receiving PgE2, or other medications, monitoring ensures that the medications are having the desired effect and that side effects do not adversely affect the baby.
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