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Physiologic diagnosis of congenital heart disease in cyanotic neonates

Desai, Kinjala; Rabinowitz, Edon J.b; Epstein, Shilpib

Current Opinion in Pediatrics: April 2019 - Volume 31 - Issue 2 - p 274–283
doi: 10.1097/MOP.0000000000000742
OFFICE PEDIATRICS: Edited by Henry H. Bernstein

Purpose of review We aim to improve diagnosis of congenital heart disease (CHD) with cyanosis by physiology for general practitioners to reduce time to appropriate treatment.

Recent findings New implementation of the critical congenital heart disease (CCHD) pulse oximetry screen has improved rate of diagnosis of CHD in recent years. However, many infants with cyanotic heart lesions often decompensate before screening in the newborn nursery, or have lesions that are not amenable to pulse oximetry screening and that present later in the emergency room. Recent literature has shown preoperative acidosis because of delayed diagnosis of cyanotic CHD worsens outcomes postoperatively. Wide availability of prostaglandin therapy and catheter procedures help to preoperatively stabilize critical cardiac patients. With a firm grasp of the underlying physiology of neonatal cyanotic CHD, practitioners can appropriately implement these therapies more judiciously. This early recognition will subsequently improve overall outcomes.

Summary Physiologic diagnosis of CHD with cyanosis by general practitioners will allow initiation of appropriate management more quickly and effectively. This may avoid progressive clinical decompensation and acidosis until cardiology consultation and potential intervention are available.

aDepartment of Pediatrics

bDivision of Pediatric Cardiology, Cohen Children's Medical Center of New York – Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA

Correspondence to Kinjal Desai, MD, Cohen Children's Medical Center of New York, Department of Pediatrics, 269-01 76th Avenue, New Hyde Park, NY 11040, USA. Tel: +1-718-470-3206; e-mail:

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