Our baby boy will be 5 weeks old on Tuesday. He has a large peri membranous VSD and couple small fenestrated ASD which was diagnosed a week after birth when we went to the ER with choking episodes with feeding. He was found to have a murmur not present at birth and echo was done and hence the diagnosis. We have 2 concerns
1. What are the chances of the large Vsd closing on its own? Better to do surgery sooner than later?
2. We have started to have difficulty with feeding him. He has a diagnosis of acid reflux and is on Zantac but was switched to Prilosec because not doing well on it. He is more somnolent and now vomiting with episodes and not wanting to take his formula and his feeds have decreased. He sweats with feeds and without as well but mostly forehead and head. He is already on lasix for his heart. We are having a very difficult time distinguishing what's cardiac and what's GI related. He is on Similac sensitive and his nutritionist increased his caloric consumption to 24 kCal. We don't know what else to do at this point?
Patients with some congenital heart defects do seem prone to GE reflux and that can complicate assessment of the effects of the VSD. However, if the baby is sweating with and without feeds, this is likely related to the large VSD. It is always our preference to try to give the child enough time to see if nature can make the VSD smaller, but if the child consistently fails to thrive despite medication and increased calories, then surgery is often needed. Additionally the location of the VSD in the wall of the heart can sometimes predict whether it has a chance of getting smaller; those in the perimembranous region do have a chance of getting smaller, but not all of them do. You should speak with your doctor to make sure that the Lasix dose is optimal for the baby's current weight, and I would agree with increasing the strength of the formula. Some babies need a feeding tube temporarily if they cannot feed fully by mouth. There is always some risk associated with open heart surgery, but if the VSD remains large over the next month or so, and the baby cannot feed or grow well, then elective surgery to close the VSD may indeed be necessary. Good luck.
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