Topic: Baby friendly hospital, congenital cyanotic heart disease
Question: Write briely on 1. Cyanotic spell in tetralogy of fallot
2. Pentavalent vaccine
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- Cyanotic Spells in Tetralogy of Fallot
- Tetralogy of Fallot is a congenital heart defect characterized by four abnormalities: ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy.
- Cyanotic spells, also called “Tet spells”, are episodes of decreased oxygen saturation that occur in children with unrepaired tetralogy of Fallot.
- Pathophysiology:
- The pulmonary stenosis and right ventricular hypertrophy cause restriction of blood flow to the lungs.
- The ventricular septal defect allows deoxygenated blood from the right ventricle to bypass the lungs and enter the left ventricle/systemic circulation.
- Any increase in oxygen demand (crying, feeding, activity) reduces the blood flow through the stenotic pulmonary valve, decreasing pulmonary blood flow and causing profound cyanosis.
- Clinical features:
- Sudden onset of crying, irritability, and agitation in an otherwise healthy-appearing infant
- Pallor and cyanosis, eventually leading to unconsciousness
- Hypoxemia, respiratory distress
- Bradycardia as hypoxia worsens
- Management:
- Knee-to-chest positioning to increase systemic vascular resistance
- Oxygen
- Morphine to reduce oxygen demand
- Beta blockers
- Definitive treatment is surgical repair of the tetralogy of Fallot
- Pentavalent Vaccines
- Pentavalent vaccines provide protection against 5 diseases: diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type B.
- The 5-in-1 combination vaccine replaces individual vaccines for each disease.
- Improves timely vaccination by reducing number of injections at each visit.
- Vaccine components:
- Diphtheria toxoid
- Tetanus toxoid
- Acellular pertussis antigens
- Hepatitis B surface antigen
- Hib polysaccharide conjugate vaccine
- Given as a series of 3 doses in infancy, with an additional booster dose later in childhood.
- Very safe and effective at generating protective antibody response to all 5 diseases.
- Reduces healthcare costs, improves compliance, and provides early protection against major causes of childhood morbidity/mortality globally.
- Endorsed by WHO as part of routine childhood immunization schedule.
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