UC Davis Health
Department of Pediatrics

Cardiovascular | Pediagogy Podcast | Department of Pediatrics | UC Davis Health

Cardiovascular

  • CCHD Screen

    Ever wonder what CCHD meant on a newborn discharge summary? Learn about how we screen for Critical Congenital Heart Defects in newborns (and which ones we miss!) in this episode.

    This episode was written by Lidia Park and Tammy Yau with content support from Heather Siefkes. Lidia and Tammy take full responsibility for any errors or misinformation.

    Key Points:

    • Critical Congenital Heart Defects (CCHD) screening looks for heart defects that can be life threatening in infancy such as coarctation of the aorta, single ventricle defects like hypoplastic left heart syndrome, Tetralogy of Fallot (ToF), pulmonary atresia, total anomalous pulmonary venous return (TAPVR), transposition of the great arteries (TGA), and tricuspid atresia (TA).
    • CCHD screening does not detect atrial septal defects (ASD), ventricular septal defects (VSD), or atrioventricular septal defects (AVSD)
    • CCHD screening is performed by checking the pulse oximeter of the right hand and either foot of a newborn. SpO2 less than 90% is an automatic fail. SpO2 differences of 3% or more or SpO2 91-95% should be repeated twice before counting as a fail. Failed CCHD’s should be followed up with an echocardiogram.

    Sources:
    CDC: Clinical Screening and Diagnosis for Critical Congenital Heart Defects | Congenital Heart Defects (CHDs) | CDC
    BMC Pediatric 2021, Jullien S. Newborn pulse oximetry screening for critical congenital heart defects. doi:10.1186/s12887-021-02520-7
    Pediatrics 2011, Kemper AR, Mahle WT, Martin GR, et al. Strategies for implementing screening for critical congenital heart disease. doi:10.1542/peds.2011-1317

  • Coarctation of the Aorta

    Unequal blood pressures in the extremities and unequal brachial vs femoral pulses? Consider coarctation of the aorta. What’s that? Learn more in today's episode!

    This episode was written by pediatricians Lidia Park and Tammy Yau with content support from Jay Yeh (UC Davis pediatric cardiologist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

    Key Points:

    • Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus (which closes and becomes the ligamentum arteriosum). Most cases occur in the first month of life.
    • Symptoms of coarctation of the aorta are tachypnea, poor feeding, fussiness, and sweating with feeds. Blood pressure is elevated in the right upper extremity compared to the lower extremity. Babies can develop congestive heart failure which can lead to shock.
    • CCHD does not always catch coarctations of the aorta!

    Sources:

    • Raza S, Aggarwal S, Jenkins P, et al. Coarctation of the Aorta: Diagnosis and Management. Diagnostics (Basel). 2023;13(13):2189. Published 2023 Jun 27. doi:10.3390/diagnostics13132189
    • Salciccioli KB, Zachariah JP. Coarctation of the Aorta: Modern Paradigms Across the Lifespan. Hypertension. 2023;80(10):1970-1979. doi:10.1161/HYPERTENSIONAHA.123.19454
    • Parker LE, Landstrom AP. Genetic Etiology of Left-Sided Obstructive Heart Lesions: A Story in Development.J Am Heart Assoc. 2021;10(2):e019006. doi:10.1161/JAHA.120.019006 

  • Kawasaki Disease

    In this episode, we have some special guests, Daniel Dodson, and one of our medical students, Aneri Patel, talk to us about Kawasaki disease. Special thanks to Natasha Nakra for content review.

    Key points:

    • Vasculitis with the clinical features in the mnemonic CRASH and Burn
    • Incomplete Kawasaki has lab features including elevated ESR and CRP, thrombocytosis, hypoalbuminemia, anemia, elevated ALT, leukocytosis, and sterile pyuria.
    • Treatment is to prevent coronary artery aneurysms with IVIG and aspirin.

    References:

  • Maintenance Fluids

    In this episode, listeners will learn about the intricacies of how the AAP guidelines came to be on maintenance intravenous fluids for pediatric patients. Get ready to learn about the 4-2-1 rule and breakdown some misconceptions about fluids based on adult data!

    This episode was written by Tammy Yau and Lidia Park with content support from Alexis Toney, Lena van der List, and Su-Ting Li. Tammy and Lidia take full responsibility for any errors or misinformation.

    Key Points:

    • Remember the 4-2-1 rule for calculating maintenance fluids in children
    • Use of hypotonic fluids is based on historical data in healthy children
    • Data now supports use of isotonic fluids like NS or LR to reduce risk of hyponatremia and SIADH
    • Newer data may support LR over NS

    Supplemental Information:

  • Obesity Management

    Let’s briefly discuss the new 2023 AAP obesity guidelines in this episode.

    Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.

    This episode was written by Tammy Yau and Lidia Park, with content support from Sean Munoz. Tammy and Lidia take full responsibility for any errors or misinformation.

    Key points:

    • Obesity is now the most common chronic disease of childhood
    • Children 10 years of age and older with obesity should have lipid, A1c, and ALT checked.
    • Children ages 2-9 with obesity should have lipid checked and potentially ALT
    • Treatment is multimodal and includes lifestyle modification, medications, and surgery.

    AAP 2023 obesity guidelines: