4mm VSD with poor feeding

[venkat1980]

Hi Dr,

My 5 days baby  boy was diagnosed having VSD  when he developed lung infection. and found that 4mm is the size and muscular ,located in the mid septum .
we noticed poor feeding and he is not putting on weight . he was 3.8kg when he was born and i am sure he is now less than that.
what do you suggest on babys growth and precautions need to be taken.
any chance of VSD closure.how frequently do we need to go for follw ups?

thanks in advance Dr

Venkat

[Jeffrey R Boris, M.D.]

Dear Venkat,

Typical weight gain is approximately 20 to 30 grams per day for a newborn infant, or 1-2 pounds per month.  With a small defect, though, there should be no specific weight loss expected, as there is no congestive heart failure due to restriction of the amount of blood that is recirculating across the hole.

[venkat1980]

Thanks for your time and reply.
when i consulted cardiologist here he said it is small VSD ( 0.4cm). what is small,medium VSD.
will there be weight loss in these cases. in general what is ideal weight gain in the first month.

Thanks
Venkat

[Jeffrey R Boris, M.D.]

Dear Venkat,

A ventricular septal defect (VSD) measuring 4 mm in a 3.8 kg baby is, at worst, medium sized.  Without seeing your son, I cannot tell for sure what he will need or what his chance of spontaneous closure of his VSD is.  However, if he is having difficulty with feeds (i.e. getting out of breath or getting sweaty with feeds), then he is having congestive heart failure.  There are medications that your cardiologist should be treating him with to reduce these symptoms.  As well, increasing caloric density of the feeds (if the baby is bottle feeding) can help.  The goal is for him to grow larger so that he can close his VSD even a little bit.  Even a small bit of closure will limit the amount of blood flow across the defect and allow him to eat without symptoms.  However, your cardiologist needs to meet with you and determine what medications/feeding interventions are needed, and how often he needs to be seen.  Overall, there is a fair chance of spontaneous closure of the VSD, but it depends on many factors, none the least of which is heart failure symptoms.  If, despite medications and other interventions, he is not able to gain weight, he will need surgical closure of the defect.