Evaluation of the cyanotic newborn: Part 2—A cardiologist’s perspective

Congenital heart disease is a major cause of cyanosis in the newborn, which should be considered and recognized promptly. Careful history and meticulous physical examination along with appropriate investigations are essential for the diagnosis of cyanotic congenital heart diseases. Although cardiac echocardiography is the diagnostic choice for congenital cardiac lesions, many centers may not have it readily available. In such cases, use of pulse oximetry, the hyperoxia test, chest radiography, and electrocardiograpy will usually differentiate heart disease from other causes of cyanosis. If a ductal-dependent lesion is suspected, the immediate initiation of prostaglandin E1 infusion may be life-saving. Understanding the pathophysiology of cyanotic congenital heart diseases is crucial in the initial management in such settings. A high index of suspicion must be maintained for the appropriate management and institution after birth-saving measures.