IMMUNIZATION PLAN

Immunization in infants less than 2500 grams of birthweight are given based on
chronological age with the number of full doses same as term infants. Immunization of
Hepatitis B should given before the patient is discharged or when chronological age ≥ 1
months old, follow up immunization need to start at 2 months of age.

ATRIAL SEPTAL DEFECT

ASD (atrial septal defect) occurs as an isolated anomaly in 5% to 10% of all

congenital heart defects. It is more common in females than in males (male-female
ratio of 1:2). About 30% to 50% of children with congenital heart defects have an ASD
as part of the cardiac defect. Three types of ASDs exist—secundum defect, primum
defect, and sinus venosus defect. Patent foramen ovale (PFO) does not ordinarily
produce intracardiac shunts. Ostium secundum defect is the most common type of
ASD, accounting for 50% to 70% of all ASDs. This defect is present at the site of fossa
ovalis,allowing left-to-right shunting of blood from the left atrium (LA) to the right atrium
(RA). Infants and children with ASDs are usually asymptomatic.
A relatively slender body build is typical. (The body weight of many is less than
the 10th percentile.) A widely split and fixed S2 and a grade 2-3/6 systolic ejection
murmur are characteristic findings of ASD in older infants and children. With a large
left-to-right shunt, a mid-diastolic rumble resulting from relative tricuspid stenosis may
be audible at the lower left sternal border. The typical auscultatory findings may be
absent in infants, even infants who have a large defect.
Earlier reports indicated that spontaneous closure of the secundum defect
occurred in about 40% of patients in the first 4 years of life (actually between 14%
and 55% of patients). The defect may decrease in size in some patients. However, a
more recent report indicates the overall rate of spontaneous closure to be
87%. In patients with an ASD <3 mm in size diagnosed before 3 months of age,
spontaneous closure occurs in 100% of patients at 1½ years of age.
Spontaneous closure occurs more than 80% of the time in patients with defects
between 3 and 8 mm before 1½ years of age. An ASD with a diameter >8 mm
rarely closes spontaneously. Most children with an ASD remain active and
asymptomatic. Rarely, congestive heart failure (CHF) can develop in infancy.
3. If a large defect is untreated, CHF and pulmonary hypertension develop in adults
who are in their 20s and 30s.
Several devices that can be delivered through cardiac catheters have been
shown to be safe and efficacious for ASD closure. These devices are applicable only
to secundum ASD with an adequate septal rim. The Clamshell device (developed by
Dr. James Lock) was used extensively and safely in many centers for closure of
ASDs (<20 mm in diameter), with an effective closure rate of 85%. Owing to
unexpected fractures of the arms of the device, it was withdrawn from the market and
is not available for clinical use in the United States, although it is available in some
other countries. The Clamshell device, however, stimulated interest in nonsurgical
closure of ASDs. At this time, several devices are being evaluated in U.S. Food and
Drug Administration clinical trials. They include the Sideris button device, Angel
Wings ASD device, CardioSEAL device, ASDOS (Atrial Septal Defect Occluder
System), and Amplatzer ASD Occlusion Device. If these devices are proved to be safe
and efficacious, they may become the procedure of choice. Advantages of nonsurgical
closure, when available, include a less than 24-hour hospital stay, rapid
recovery, and no residual thoracotomy scar. All these devices are associated with a
higher rate of small residual leak than is operative closure.
In this patient we found a small secundum ASD with diameter 2-2,5 mm and
there is no pharmacological treatment for this case. We plan to evaluate the cardiac
defects 6 months after the first echocardiography.