Diagnosis and management of life-threatening cardiac malformations in the newborn

• Published in: Seminars in fetal & neonatal medicine Vol. 18; no. 5; pp. 302 - 310
• Main Author: Mellander, Mats
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.10.2013
• Subjects: Aortic coarctation; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - trends; Congenital heart defects; Diagnostic Errors - prevention & control; Heart - physiopathology; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Heart Defects, Congenital - therapy; Humans; Infant, Newborn; Neonatal and Perinatal Medicine; Neonatal screening; Neonatal Screening - methods; Neonatal Screening - trends; Newborn; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Pulse oximetry screening; Severity of Illness Index; Transposition of the great vessels; Aortic coarctation; Newborn; Transposition of the great vessels; Pulse oximetry screening; Congenital heart defects; Neonatal screening
• ISSN: 1744-165X; 1878-0946
• DOI: 10.1016/j.siny.2013.04.007

Summary Approximately 1–2 per 1000 newborn babies have a cardiac defect that is potentially life-threatening usually because either the systemic or the pulmonary blood flow is dependent on a patent ductus arteriosus. A significant proportion of newborns with such cardiac defects are being discharged from well-baby nurseries without a diagnosis and therefore risk circulatory collapse and death. This risk is greatest for defects with duct-dependent systemic circulation, notably aortic arch obstruction, but is also significant in transposition of the great arteries, for example. The solution to this problem, apart from improving prenatal detection rates, is to introduce effective neonatal screening including routine pulse oximetry.